diabetes – anaesthetic management
TRANSCRIPT
-
7/29/2019 Diabetes Anaesthetic Management
1/82
Diabetes Anaesthetic Management
Complications, Diabetic Ketoacidosis
Co-ordinator Dr. Gurjeet Khurana
Presented by Dr. S. D. Arya
-
7/29/2019 Diabetes Anaesthetic Management
2/82
Diabetes Mellitus
-
7/29/2019 Diabetes Anaesthetic Management
3/82
WHO definition
Symptoms + plasma glucose conc > 11.1 mmol/l
Two fasting glucose conc > 7 mmol/l
Two random glucose conc > 11.1 mmol/l, if pt is
asymptomatic
-
7/29/2019 Diabetes Anaesthetic Management
4/82
WHO criteria for oral GTT
Unrestricted carbohydrate diet for 3 days
Fasted overnight ( for at least 8 hrs)
Rest before test (30 mins)
Plasma glucose measured before & 2 hrs after75 gm glucose load
-
7/29/2019 Diabetes Anaesthetic Management
5/82
GTT Glucose conc
whole blood plasma
venous capillary venous capillary
(mg/dl)
DiabetesFasting 126 110 126 110
2 hrs after 200 180 220 200
Impaired glucose toleranceFasting < 126 < 110 < 126 < 110
2 hrs after 140-200 120-180 160-220 140-200
-
7/29/2019 Diabetes Anaesthetic Management
6/82
Insulin Secretion
86 AA precursor polypeptide preproinsulin
proteolysis proinsulin insulin
Glucose > 70 mg/dl insulin synthesis Insulin secretion begins with its transport into
cells by GLUT 2 glucose transporter
Glucose phosphorylation by glucokinase ratelimiting step
-
7/29/2019 Diabetes Anaesthetic Management
7/82
Effects of Insulin
On liver promotes glycogenesis, es synthesis
of triglycerides, cholesterol, VLDL
es glycogenolysis, ketogenesis,
gluconeogenesis On muscle promotes protein synthesis
promotes glycogen synthesis
On fat promotes triglyceride storage
es glucose transport into fat cells
es intracellular lipolysis
-
7/29/2019 Diabetes Anaesthetic Management
8/82
Blood Glucose Regulation
Liver blood glucose buffer system
Insulin & glucagon feedback control system
Hypothalamus epinephrine
Growth hormone, cortisol
Importance: brain, retina, germinal epth of gonads
uses glucose as the only energy source
-
7/29/2019 Diabetes Anaesthetic Management
9/82
Excess glucose ECF fluid extra cellular
hyperosmolality cellular dehydration
Glycosuria
Osmotic diuresis polyuria, polydipsia
depletion of fluid & electrolytes
Lipolysis - ed serum fatty acid conc
ed protein synthesis
-
7/29/2019 Diabetes Anaesthetic Management
10/82
Diabetes Risk Factors
Family history of type 2 DM
Overweight (BMI > 25 kg/sqm)
Habitual sedentary physical activity
High risk ethnic groups
H/O gestational diabetes
H/O large babies (birth wt > 9 lbs)
Hypertension
Hyperlipidemia ( high triglycerides, low HDL)
-
7/29/2019 Diabetes Anaesthetic Management
11/82
-
7/29/2019 Diabetes Anaesthetic Management
12/82
Comparative C/F of Type 1 & 2 DM
Type 1 Type 2
Age onset < 40 yrs > 40 yrs
Duration of symptoms weeks monthsyrs
Body wt N or low obeseKetonuria yes no
Autoantibodies yes no
Family history uncommon commonOther autoimmune d common uncommon
Compl at diagnosis no 25%
Death without insulin yes no
-
7/29/2019 Diabetes Anaesthetic Management
13/82
S/S of hyperglycemia
Thirst Dry mouth
Polyuria Polydipsia
Tiredness, fatigue Headache
Recent change in wt
Blurring of vision
Nausea
Mood change, irritability
-
7/29/2019 Diabetes Anaesthetic Management
14/82
Investigations
Blood glucose
Glycosylated Hb Hb A1c over 60 days of 1% Hb A1c means of 2 mmol/l BG
non diabetic range < 6.05%goal in IDDM < 7.5%> 9% - osm diuresis, water &
electrolyte loss12-15% - verge of DKA
Urine sugar & ketones
-
7/29/2019 Diabetes Anaesthetic Management
15/82
Insulin & oral hypoglycemics
-
7/29/2019 Diabetes Anaesthetic Management
16/82
-
7/29/2019 Diabetes Anaesthetic Management
17/82
-
7/29/2019 Diabetes Anaesthetic Management
18/82
-
7/29/2019 Diabetes Anaesthetic Management
19/82
Prevention of insulin adsorption on tubing &
glass bottles
Add albumin/polygelline
Add pts own blood
Flushing with 50 ml saturates binding sites
Use conc insulin small vol
-
7/29/2019 Diabetes Anaesthetic Management
20/82
Disadv/problems with insulin
i.v. bolus
Very short half life (6-8 mins)
Unphysiological
ed chances of hypoglycemias.c.route
Marked individual variations in absorption
Altered cutaneous blood flow fluid shifts &haemodynamic changes
Delayed onset
Immediate titration not possible
-
7/29/2019 Diabetes Anaesthetic Management
21/82
Anaesthetic Management
-
7/29/2019 Diabetes Anaesthetic Management
22/82
Anaesthetic Management Goals
To maintain glycaemic control
To avoid further deterioration of pre existing endorgan disease
To shift patient soon on pre operative glycaemic
control drugs
-
7/29/2019 Diabetes Anaesthetic Management
23/82
Pre operative assessment - Aims
Type of DM, its duration & t/t
Evaluation & t/t of end organ damage:
responsible for 5 fold in peri operative mortality
Assessment of BS control & to obtain controlwith short drugs
Assessment for cardioresp fn., IHD, CVD, renal
dysfn, peripheral neuropathy, joint mobility,retinopathy
Limit hospital stay & cost
Quantification of risk
-
7/29/2019 Diabetes Anaesthetic Management
24/82
PAC
Assessment History/exam Invsg
BS control hypo/hyper gly BS-F & PP
episodes Hb A1 C
hospitalizationmedical t/t
Nephropathy H/O HT R/M urine
H/O recurrent UTI microalb
oedema KFT
-
7/29/2019 Diabetes Anaesthetic Management
25/82
Assessment History/exam Invsg
Cardiac status H/O angina, MI ECG
exercise tolerance ECHOdyspnea, swelling chest x-ray
PVD H/O intermittent
claudication, non
healing ulcersRetinopathy H/O visual disturbance fundus
ing lens power exam
Stiff jt syndrome X ray
cervical spine (lat)
Metabolic & ABG
electrolytes S electrolytes
ANS
-
7/29/2019 Diabetes Anaesthetic Management
26/82
Autonomic Nervous System Neuropathy
Hypoglycemic unawareness
Deconditioning
Greater in presence of systemic hypertension
renal failureperipheral sensory neuropathy
-
7/29/2019 Diabetes Anaesthetic Management
27/82
Cadiovascular manifestations
Resting tachycardia lack of vasoconstriction
due to sympath NS stimulation Orthostatic hypotension norep es less in
standing position
ed or absent beat to beat variability of HR in
response to deep breathing cardiac vagaldenervation
HR response to drugs viz atropine, propranololblunted
Shortening of QT interval dysrhymias Prevent angina, cause sudden MI
Unexplained hypotension may be due topainless MI
-
7/29/2019 Diabetes Anaesthetic Management
28/82
Resp system
ed vent response to PaCO2 & PaO2
ed susceptibility to vent depressant drugs
FVC & FEV
ed 2,3,DPG
More chances to resp tract infection
DM affects O2 transport glucose binding to Hbmol & altering allosteric intetactions b/w chains
-
7/29/2019 Diabetes Anaesthetic Management
29/82
Sudden death syndrome
May manifest as sudden death syndrome ed incidence of post op cardio resp arrest
Sudden unexpected profound bradycardia
responsive only to epinephrine
Gastroparesis
Delayed gastric emptying
Nausea, vomiting, diarrhoea, abd distension
Metoclopramide
-
7/29/2019 Diabetes Anaesthetic Management
30/82
Stiff joint syndrome
Limited joint mobility
Prayers sign, Palm print testAtlanto occipital jt
Non familial short stature, tight waxy skin
Glycosylation of tissue proteins responsible
Diabetic scleredema
Thickening & hardening of skin Induration non pitting & symmetrical
Ant spinal artery syndrome
-
7/29/2019 Diabetes Anaesthetic Management
31/82
Others
ed A-V shunting
ed skin capillary blood flow
ed sweating neuropathic foot
Greater intra op core body temp es delayed
onset of thermoregulatory vasoconstriction
-
7/29/2019 Diabetes Anaesthetic Management
32/82
PAC Orders
Consent NPO Orders
Anxiolytics Aspiration prophylaxis
Stop long acting insulin night before Sx
Morning sample of BS & serum electrolytesMorning i.v. fluids according to regimen
Arrange for dextrose, insulin etc.
Careful transfer of patient
To be taken as first case in morning
-
7/29/2019 Diabetes Anaesthetic Management
33/82
Classification of surgeries
Minor - < 30 mins; unlikely to interfere with t/t
Intermediate 30 min - 2 hrs; might interfere on
day of Sx
Major - > 2 hrs; likely to interfere with Mx & diet
-
7/29/2019 Diabetes Anaesthetic Management
34/82
Peri operative glucose/insulin therapy - Goals
Provide adequate carbohydrate -
normal obligatory requirement 180 gm/day
rate of infusion 5-10 gm/hr (1.2-2.4 mg/kg/d)
5% D i.v. @ 125 ml/hr
Mimic physiologic condition 1-2 unit insulin/hr
Simple practical & error free regimen
Correction of acid/base electrolyte imbalance
Maintain BS @ 120 - 180 mg/dl
-
7/29/2019 Diabetes Anaesthetic Management
35/82
No insulin, no glucose
Partial morning dose insulin (s.c.) with dextrose
-
7/29/2019 Diabetes Anaesthetic Management
36/82
Sliding Scale
-
7/29/2019 Diabetes Anaesthetic Management
37/82
Albertis Regimen (Type 1 DM)
Stabilize BG 2-3 days prior to Sx
Shift to short acting insulin on day before Sx Omit morning dose of insulin
Start GKI (10, 10, 10) after checking BG & K+ @
100 125 ml/min 2 3 hrly B sugar level charting
-
7/29/2019 Diabetes Anaesthetic Management
38/82
contd.
B sugar Infusion< 90 mg/dl 10% D + 5 U + 10 K+
90 180 10 + 10 + 10
180 360 10 + 15 + 10
> 360 10 + 20 + 10
-
7/29/2019 Diabetes Anaesthetic Management
39/82
contd.
Post op GKI @ 100 125 ml/hr, check B sugar4 hrly, till pt starts orally
Stop GKI, give regular insulin
Dose 20% extra, if steroids intake or infection
No lactate containing fluids
-
7/29/2019 Diabetes Anaesthetic Management
40/82
Albertis Regimen (Type 2 DM)
Diet controlled treat as normal pt., check BS
On OHA uncontrolled insulin
controlled OHA to continue 1 day prior to Sxstop all biguanides
stop long acting sulfonylureas 3-4
days prior, shift to tolbutamide
no OHA on day of Sx
-
7/29/2019 Diabetes Anaesthetic Management
41/82
contd.
Minor Sx manage as non diabetic, if BS control
Major Sx start GKI infusion
Post operatively
Minor Sx OHA, dose with first meal
full dose next day
Major Sx continue GKIregular insulin once pt starts orally
-
7/29/2019 Diabetes Anaesthetic Management
42/82
Tight Control Regimen
To keep BS in 99-120 mg/dl
Indicated in pregnancy, CPB, neurological &
cardiac Sx
Adv. improves wound healing, prevents wound
infection, improves neurological outcome,
improves weaning from CPB
Disadv. no monitoring of K+ , more chances ofhypoglycemia, difficult in ward settings,
meticulous monitoring
-
7/29/2019 Diabetes Anaesthetic Management
43/82
contd.
Pre-prandial G, night before Sx
Start 5% D @ 50 ml/hr
Piggy back insulin, 50 U in 250 ml NS
Flush initial 60 ml to saturate insulin binding sites
Infusion rate @ BS/150 ml/hr (100, if pt on steroid,sepsis, obesity)
4 hrly BS monitoring
Intraop 1-2 hrly monitoring If BS < 50, give 15 ml of 50% D
-
7/29/2019 Diabetes Anaesthetic Management
44/82
-
7/29/2019 Diabetes Anaesthetic Management
45/82
Post op complications
Hypoglycemia Hyperglycemia
Infection Delayed wound healing
Peri op ed MI risk : watch for 72 hrs
Problems due to autonomic neuropathy
PONV Pain
Restoration of routine OHR
-
7/29/2019 Diabetes Anaesthetic Management
46/82
DM with renal failure
Alberti regimen not suitable fluid overloadadditional K+
For major Sx H.A.@ 1 unit/ml, adjusted20% D @ 40 ml/hr,10% or 5% in stressful condsliding scale or s.c. in post-op
For minor Sx morning dose omitted, 5% D @40 ml/hr
Pt on dialysis insulin in dialysis bags, omittedfrom overnight bags
-
7/29/2019 Diabetes Anaesthetic Management
47/82
DM & Obesity
ed risk of post op resp failure, atrial & vent
arrhythmias, renal insufficiency, leg wound
infection
Metabolic syndrome hyperglycemia with
insulin resistance, hypertension, central visceral
obesity, dyslipidemia (high TG & low HDL)
-
7/29/2019 Diabetes Anaesthetic Management
48/82
DM & Emergency Sx
Usually infected, uncontrolled, dehydrated
Metabolic decompensation
Resistance to insulin Little time for stabilization but 2-3 hrs sufficient to
correct fluid & electrolyte imbalance
If Sx lead to further metabolic deterioration,correct ketoacidosis first
-
7/29/2019 Diabetes Anaesthetic Management
49/82
Propofol infusion in Diabetic pts
Lipid load resulting from propofol infusion may
lead to impairment of metabolism, in ICU set up
Unlikely to be relevant during induction
-
7/29/2019 Diabetes Anaesthetic Management
50/82
Etomidate & Midazolam in DM
Etomidate : inhibitory effect on adrenal steroid
genesis & glycaemic response to
Sx
Midazolam - ACTH & cortical secretion
sympathoadrenal activity,
stimulates GH secretion.
Net effect is ed glycaemic response to Sx
-
7/29/2019 Diabetes Anaesthetic Management
51/82
Clonidine glycaemic control improved due to
ed sympathoadrenal activity.
inhibits ACTH release withstimulation of GH release
-
7/29/2019 Diabetes Anaesthetic Management
52/82
Regional Anaesthesia
Advantages
Disadvantages
-
7/29/2019 Diabetes Anaesthetic Management
53/82
Complications of DM
-
7/29/2019 Diabetes Anaesthetic Management
54/82
Acute complications
Diabetic ketoacidosisDiabetic nonketotic hyperosmolar coma
Hypoglycemia
Lactic acidosis
-
7/29/2019 Diabetes Anaesthetic Management
55/82
Chronic complications
Microvascular retinopathy
nephropathyneuropathy
Macrovascular cerebrovascular
cardiovascular
peripheral vascular disease
-
7/29/2019 Diabetes Anaesthetic Management
56/82
Diabetic Ketoacidosis
Ketoacidosis is a state of of uncontrolled catabolism a/winsulin deficiency.
Glucose Ketones
Hyperglycemia Acidosis
Glycosuria
Vomiting
Osmotic diuresisFluid & eletrolyte depletion
Renal hypoperfusion impaired excretion of
ketones & Hydrogen ions
-
7/29/2019 Diabetes Anaesthetic Management
57/82
Pathogenesis of DKA
Insulin deficiency
Increased counter regulatory hormones -
glucagon, cortisol, GH, catecholamines
Dehydration -osmotic diuresis of hyperglycemia
fluid deprivation due to GIT disturbancehydration reduces hyperglycemia
without altering acid-base balance
-
7/29/2019 Diabetes Anaesthetic Management
58/82
Insulin deficiency
Activated lipolysis
ed plasma FFA conc
ed hepatic fatty acids
ketogenesisactivation of Carnitine
Acyltransferase
ed hepatic carnitineed Malonyl CoA content
Glucagon excess
-
7/29/2019 Diabetes Anaesthetic Management
59/82
Causes -
previously undiagnosed diabetes
interruption of insulin therapy
stress of intercurrent illness, MIinfection
emotional disturbance
-
7/29/2019 Diabetes Anaesthetic Management
60/82
Clinical features
Symptoms - Signs -
Nausea, vomiting Tachycardia
Thirst, polyuria Dry mucus memb
Abdominal pain ed skin turgor
Altered mental function Tachypnea
Sluggish/extreme tiredness Kussmaul resp
Fruity smell in breath FeverShortness of breath Lethargy, coma
-
7/29/2019 Diabetes Anaesthetic Management
61/82
Laboratory findings :
BG 300 600 mg/dl
Eugenic DKA BG < 350 mg/dl
in alcoholic, pregnancy, young pts
Acid Base abnormality:
bicarbonate level ed
ed anion gap
pH 6.8-7.3arterial pCO2 20-30 mmHg
s. bicarbonate - < 15 mEq/l
-
7/29/2019 Diabetes Anaesthetic Management
62/82
Fluid & electrolytes :
5-8 lt fluid deficit (100 ml/kg)
Na 125-135 mEq/l (deficit 350-600 mEq)
K normal ored (deficit 200-400 mEq)
Mg, Cl - normal
Phosphate - ed
Creatinineslightly ed
Osmolality : 320 340 mOsm/llowest osmolality a/w stupor or coma in
DKA is 320 mOsm/l
-
7/29/2019 Diabetes Anaesthetic Management
63/82
Management :
Invg electrolytes, BG, arterial blood gases,
TLC, ketone stick tests, chest x-ray, bloodculture
Oxygen, NG tube, urinary catheter, CVP, ECG
Antibiotics
Fluid therapy 0.9% NS 1 lt in 30 mins
1 lt hourly for 2 hrs
1 lt 2 hrly
1 lt 2-4 hrly
change to 5%D when BG 180-270 mg/dl
-
7/29/2019 Diabetes Anaesthetic Management
64/82
Insulin
s.c., i.m. route
i.v. route
0.4 u/kg: bolus half i.v.
0.15 u/kg bolus half s.c.or i.m.
0.1 u/kg as infusion
0.1 u/kg/hr sc or imif BG does not fall by 50-70 mg/dl in first hr
double insulin infusion hrly iv bolus(10 u )
when BG reaches 250 mg/dl
change to 5%D + 0.45% NaCl 150-200 ml/hr+insulin(0.05-0.1 u/kg/hr i.v.) or 5-10 u s.c. every 2 hr
-
7/29/2019 Diabetes Anaesthetic Management
65/82
K+ supplementation
if initial S.K < 3.3 mEq/l hold insulin, give 40mEq/hr K until S.K 3.3 mEq/l
if initial S.K 5 mEq/l do not give K, check S.Kevery 2 hr
if initial S.K b/w 3.3-5 mEq/l give 20-30 mEq K
in each lt fluid
Keep S.K b/w 4 - 5 mEq/l
-
7/29/2019 Diabetes Anaesthetic Management
66/82
Bicarbonate
pH < 6.9 6.9-7.0 > 7.0
NaHCO3 (100 mmol) 50 mmol no bicarb
in 400 ml fluid in 200 ml
@ 200 ml/hr @ 200 ml/hr
repeat HCO3 every 2 hr until pH 7.0
-
7/29/2019 Diabetes Anaesthetic Management
67/82
Hyperosmolar Hyperglycemic Non Ketotic Coma
Severe hyperglycemia - > 600 mg/dl
Vol depletion ~ 25% of total body water
Hyperosmolarity - > 350 mosm/kg
Normal pH, absence of symptoms
Osmotic diuresis dehydration, somnolence,
coma
Ppt factors advanced age, sepsis,hyperalimentation using conc carbohydrate
soln
-
7/29/2019 Diabetes Anaesthetic Management
68/82
contd.
Pathophysiology relative insulin def &inadequate fluid intake
Each 100 mg/dl in BG es plasma Na+by
1.6 mEq/l
T/t hypotonic saline
low dose i.v. insulin
K+ supplementation
-
7/29/2019 Diabetes Anaesthetic Management
69/82
DKA HONK
Glucose 250-600 600-1200
Osmolality 320-340 330-380
pH 6.8-7.3 > 7.3
Potassium N, or N or
Bicarbonates < 15 N to slightly Sodium 125-135 135-145
pCO2 20-30 N
Anion gap N to slightly
Ketones ++++ +/-Creatinine slightly moderately
Mg, Cl N N
-
7/29/2019 Diabetes Anaesthetic Management
70/82
Hypoglycemia
More common than DKA in IDDM pts
Min 36-54 mg/dl glucose necessary for CNS fn
Sym NS activated diaphoresis, tachycardia,
neuroglycopenia, impairedcognition, confusion, headache,
irritability, retrograde amnesia,
seizures, unconsciousness
Symptoms appear when BG falls to 40 mg/dl or
abrupt from 300 mg/dl to 100 mg/dl
Counter regulatory hormones secreted stimulate
-
7/29/2019 Diabetes Anaesthetic Management
71/82
Counter regulatory hormones secreted, stimulatehepatic glucose release
Hypoglycemia during stress, exercise, sleep or in
alcohol ingestion may not result in recognizedsymptoms
IDDM pts on insulin therapy manifest loweredglucose threshold for glucagon release (35mg/dl)
T/t rapidly absorbed carbohydrate orally, 15 gm,180 ml orange juice25 ml of 50% glucose i.v.Glucagon 1 mg i.m./i.v.
Repetitive episodes of severe hypoglycemia resultin cognitive deficits
-
7/29/2019 Diabetes Anaesthetic Management
72/82
Lactic Acidosis
Type B lactic acidosis Usually in pts on Metformin
Pt very ill, over breathing, severely dehydrated,breath does not smell of acetone,ketonuria mild or absentplasma HCO3 & pH ed pH < 7.2
H+ > 63 mmol/lanion gap
lactic acid > 5 mmol/l
T/t NaHCO3 + insulin & glucosesod dichloroacetate
-
7/29/2019 Diabetes Anaesthetic Management
73/82
Retinopathy
Related to degree & duration of hyperglycemia
Pregnancy is a risk factor
Microaneurysms near maculla responsible forcentral vision & visual acuity
Terminal capillaries obstructed, retina ischaemic
Proliferation of new vessels
T/t photo coagulation of leaking vessels with
argon laser
-
7/29/2019 Diabetes Anaesthetic Management
74/82
Nephropathy
Micro albuminuria Macro albuminuria
Hypertension nephrotic syndrome - GFR
end stage renal disease
Controlling B.P., low protein diets - progress
ACE inhibitors delay onset & slow progress
T/t dialysisrenal transplantation
-
7/29/2019 Diabetes Anaesthetic Management
75/82
Yrs after DM Clinical course
0 enlarged kidney, microalbuminuria
2 glm basement thickening, in
mesangial matrix
10-15 microalbuminuria
10-20 persistent proteinuria, in glm fn
azotemic period
20 uremic period, diabetic
retinopathy, hypertension,
nephrotic syndrome
-
7/29/2019 Diabetes Anaesthetic Management
76/82
Cardiovascular Disease
Risk factors in NIDDM obesity, hypertension,
dyslipidemia (high LDL)
hyperglycemiawith nephropathy a/w high IHD
Combination of peripheral neuropathy &
peripheral vascular disease results in higher risk
of amputation
-
7/29/2019 Diabetes Anaesthetic Management
77/82
Peripheral Neuropathy
Symmetrical sensorimotor neuropathy:numbness, tingling in toes, feet
Depend on duration of NIDDM
Hypoesthesia, parasthesia, dysthesia,anaesthesia
Insensitive foot vulnerable to trauma,
neuropathic foot ulcers gangrene amputation
Acute hyperglycemia es nerve fn & chronic
hyperglycemia a/w axonal degeneration, loss of
myelinated & unmyelinated nerve fibers
-
7/29/2019 Diabetes Anaesthetic Management
78/82
cotnd.
Mononeuropathies asymmetrical, affect cranial
or peripheral nerves. Is sec to vascular
occlusion leading to nerve infarcts.
Radial N, common peroneal N Entrapment syndrome ulnar N at cubital tunnel
median N at carpal tunnel
Unavoidable pressure on extremities a/wpositioning during anaesthesia & Sx -
exacerbates
-
7/29/2019 Diabetes Anaesthetic Management
79/82
Pancreas Transplant Recipients
Restores normal glucose metabolism
Do not require insulin to compensate for stress
response to Sx
Catecholamine response to hypoglycemia notdocumented
Chronic dysuria due to amylase in urine
Loss of HCO3 & water dehydration &
metabolic acidosis
-
7/29/2019 Diabetes Anaesthetic Management
80/82
New treatments for DM
Implanted (like a pacemaker) glucose analyzerwith electric transmission to a surface (watch)
monitor
Glucagon like peptide receptor antagonist: GIP-1 New islet implantation medication that makes
islet cells transplants more successful &
rejection medication less hazardous
Medications viz INGAP peptide: regrowth of
normally functioning islet cells
-
7/29/2019 Diabetes Anaesthetic Management
81/82
Inhaled insulin - Exubera
Fast acting, dry powder formulation, orally
inhaled before meals
Loss during pulm inhalation
5 unit exubera = 1 unit of injected form
Lung disease caution
PFTs checked before starting, & checked every
6-12 months
-
7/29/2019 Diabetes Anaesthetic Management
82/82
THANK YOU