Figure SC12 Complications

The complications of diabetes are listed in Figure SC. 12.

Patients with diabetes may present for incidental surgery or for surgery related to their diabetes, particularly abscesses, wound debridement, amputation of toes, feet or limbs, and cataract surgery, although diabetic patients do not have a higher incidence of cataracts, simply an earlier presentation of the condition. Whether the surgery is incidental or not, and whether the diabetes is insulin or non insulin dependent, there is an interaction between the surgical insult and the diabetes that needs to be properly managed to maintain stability and avoid further complications of both the diabetes and the surgery. Inadequately managed diabetes can result in hyper- or hypoglycaemia, ketoacidosis, wound infection and delayed healing. Occasionally the surgical condition can result in instability and toxic confusion, which will, of course, make the diabetes more unstable and worsen the surgical condition. Patients should not be presented for anaesthesia unless their diabetes is under reasonable control with blood glucose between 3 and 10 mmol/1 during the pre-operative fasting period. Any patient whose blood glucose is outside this range should have their surgery postponed until the situation has been corrected, unless the surgical condition is a true emergency. Similarly, any tendency to acidosis or ketosis and any coexisting electrolyte disturbance must be fully corrected before anaesthesia. Unfortunately, there are many patients with gangrene or infection of ischaemic tissue whose diabetes will not come into adequate control until debridement has been carried out. This should not prevent the attempt being made. Patients presented for elective surgery should be seen by a physician with a special interest in diabetes before the day of operation so that their diabetes is under optimal control.

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