Type 1 diabetes mellitus
Patient (condition)
 
Aliases:
IDDM
Insulin dependent diabetes

Topic aliases are alternate phrasings for a particular topic.


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Absolute insulin deficiency resulting from a reduction in insulin production by pancreatic beta islet cells. Disease is marked by an inability to use carbohydrates resulting in ketoacidosis, and upregulation of gluconeogenesis and glycogenolysis resulting in hyperglycemia. Individuals with type 1 diabetes depend completely on insulin. Anesthethic considerations revolve around the assessment of organ damage including the cardiovascular and renal systems, and planning of a perioperative insulin regimen.

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Dec 17, 2012
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Gastroparesis is a complication of long standing diabetes, increasing risk of residual gastric contents & aspiration. Elicit from history, or assume it's presence in longstanding, brittle disease.

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Jul 20, 2011
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Elevated risk of coronary artery disease. If major elective surgery & symptomatic, investigate. Consider that diabetic neuropathy may result in patient suffering from "silent" ischaemia

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Jul 20, 2011
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Insulin supplementation will be required for Type I diabetics having any surgery.

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Oct 06, 2011
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The initial hourly insulin infusion can be calculated by dividing the patient's total daily dose by 24. Commence this 2hrs prior to surgery. refl.in/3y

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Oct 07, 2011
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An insulin infusion can be prepared by placing 100u of rapid acting insulin (eg actrapid) in 100ml of Normal Saline. refl.in/3y

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Feb 01, 2012
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Consult endocrinologist for a perioperative insulin regime for any patient with brittle disease or complex therapy

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May 18, 2011
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Consult your local peri-operative insulin guideline.

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Oct 17, 2011
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Dextrose 5% (D5W) + 20mmol KCL should be run concurrently with insulin to prevent glycogenolysis & protein catabolism. #ref

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Jul 20, 2011
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If the patient uses an insulin pump, the rate should be reduced by 30% to run at 70% basal rate night before surgery. Ref: Stoelting Anaes Coexist Disease p375 refl.in/3y

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Jul 20, 2011
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Insulin pump should be run at basal rate perioperatively, or equivalent dose administered as infusion. refl.in/3y

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May 18, 2011
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If brittle disease, consider admitting night before surgery for monitoring of BSL & insulin/dextrose infusion whilst fasting

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May 18, 2011
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If unwell, consider delaying surgery, where possible, by 4-6hrs to optimise fluid and metabolic state prior to surgery to prevent DKA Ref: Stoelting Anaes Coexist Disease p573 refl.in/3y

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May 18, 2011
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Place first on list to minimise fasting time

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Sep 13, 2011
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Preop, hourly, & recovery blood sugar/glucose levels aiming 6-10 mmol/L BSL BGL #ref

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Jul 20, 2011
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Autonomic neuropathy can result in postural hypotension. Consider the risks in upright positions such as beach chair and sitting position.

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Oct 06, 2011
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Stress response can precipitate hyperglycaemia. Minimise with adequate analgesia & optimal haemodynamics refl.in/3y

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May 18, 2011
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Diabetic cheiroarthropathy & connective tissue glycosylation seen in some long term diabetics may result in c-spine and TMJ stiffness & difficult laryngoscopy

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Oct 06, 2011
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Increase the acceptable lower end blood glucose level in patients with poorly controlled diabetes to 4mmol/L.
The blood glucose level at which patients with poorly controlled diabetes develop hypoglycaemic symptoms is higher than patients with well controlled or no diabetes.
www.ncbi.nlm.nih.gov/pubm...

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May 03, 2012
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Run D5W with insulin infusion to prevent hypoglycemia. 150m/hr if BSL<100mg/dL(5.6mmol). 75ml/hr if BSL 100-150mg/dL(5.6-8mmol). 50ml/hr if BSL 150-200mg/dL(8-11mmol). TKVO if BSL >200mg/dL(11mmol)

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Oct 06, 2011
Stoelting refl.in/3y
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Typical rate of insulin infusion is 0.02u/kg/hr. If CABG, 0.06u/kg/hr, steroids or severe infection 0.04u/kg/hr refl.in/3y

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May 18, 2011
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Typically, one unit of insulin lowers the glucose by 25-30mg/dL (1.4-1.6mmol) refl.in/3y

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