(BQ) Part 2 book “Care of people with diabetes” has contens: Management during surgical and investigative procedures, conditions associated with diabetes, diabetes and sexual and reproductive health; women, pregnancy, and gestational diabetes; diabetes education; managing diabetes at the end of life, and other contents. | Chapter 9 Management During Surgical and Investigative Procedures SURGICAL PROCEDURES Key points • Surgery induces the counter-regulatory response that can increase the blood glucose 6–8 times higher than normal in people with and without diabetes. Optimal control before, during, and after surgery reduces morbidity and mortality and length of stay. • Preventing hyperglycaemia reduces the risk of adverse outcomes in people with diabetes. • Morning procedures are desirable. • Insulin should never be omitted in people with Type 1 diabetes. • Complications should be stabilised before, during, and after surgery. • Cease oral glucose lowering medicines 24–36 hours before the procedure depending on the particular medicine and their duration of action; but note some experts recommend continuing oral agents until the day of surgery if the blood glucose is high. • Ascertain whether the person is using any complementary therapies especially herbal medicines with a high risk of interacting with conventional medicines and/or causing bleeding. • An insulin-glucose infusion is the most effective way to manage hyperglycaemia in the operative period. Rationale Diabetes is associated with an increased need for surgical procedures and invasive investigations and higher morbidity than non-diabetics. Anaesthesia and surgery are associated with a complex metabolic and neuroendocrine response that involves the Care of People with Diabetes: A Manual of Nursing Practice, Fourth Edition. Trisha Dunning. © 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd. 278 Care of People with Diabetes release of counter-regulatory hormones and glucagon leading to insulin resistance, gluconeogenesis, hyperglycaemia and neutrophil dysfunction, which impairs wound healing. The stress response also occurs in people without diabetes but is more pronounced and difficult to manage in people with diabetes due to the underlying metabolic abnormalities. Advances in diabetes management, .
