Running head: Management of Hyperglycemia

Perioperative Management of Hyperglycemia.
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Ohlone College
Nur 302

Abstract.
Diabetes Mellitus is leading cause of hyperglycemia. Without proper treatment increased glucose level could lead to many post operational complications. Most of these complications can be avoided with blood glucose control. Continuous insulin infusion is best way to keep Glucose level within normal limits. Many factors could increase blood glucose level, thus it is important that all health care workers contribute to developing treatment (glucose control) plan for each patient.

Perioperative Management of Hyperglycemia.
Diabetes mellitus is a complex disease of proteins, fat, and carbohydrates metabolism which caused by lack of insulin production or cell’s resistance to insulin. Insulin is responsible for blood glucose transmission to the cells and without it glucose level increases, leading to hyperglycemia. Uncontrolled hyperglycemia leads to serious long term health problems related to macroangiopathy and microangiopathy (Lilley, Harrington, & Snyder, 2005). In United States around 17,000,000 adults diagnosed with diabetes. 9.5 million are females (Diabetes mellitus statistics) . Every fourth patient who was hospitalized had Diabetes mellitus (DM). Their care costs around $40 billion per year (Patel, 2008). One of the major reasons for hospitalization is a surgery. (Mokshagundam, 2004). With progression of DM patients face many complications and many of this complications leading to surgical invasions. COBG, Laser coagulation (to seal or destroy leaking blood vessels in the retina (Rhodes, 2007)), lower extremity amputations and surgery procedure for foot infections are most common surgeries with DM patients. Management of glucose level in perioperative period is very complicated, but need to be improved in order to see after surgery better outcomes (Mokshagundam, 2004).
There are many studies done to see relationship between blood glucose level and infection and wound healing outcomes. Some study shows that rate in people with DM are much higher than in patient without diabetes and in some cases rate of DM infection cases could be ten times higher (Mokshagundam, 2004). Increased level of infection can be explained by high glucose content in all body fluids and it provide “ideal medium” for bacteria growth. Also patient with DM who went though surgery have low immune response to antigens. As a result low bacteria count needed to change from colonization state to infection (Patel, 2008). There is also relationship between high glucose level ( >220mg/dL) on postoperative day and increased risk of wound infection (Mokshagundam, 2004). Other research results demonstrate that intensive insulin treatment with insulin drip shows low mortality rate and decreased some secondary outcomes, such as renal insufficiency, anemia, and neuropathy (Mokshagundam, 2004). Tight glucose control improves survival rate and reduces morbidity and complications. Sliding scale insulin administration does not provide good control of Glucose level. Continuous insulin infusion has better control over blood glucose and shows better outcomes in DM patients (Patel, 2008).
In the hospital many things can contribute to increased blood sugar level. These could be pain, stress, infection, and use of some medications (Mokshagundam, 2004). Also, it could be patient’s tests never show high blood glucose but right before the surgery. “Unrecognized diabetes” probably won’t receive aggressive insulin therapy and as result poor glucose control could lead to hyperglycemia. With “unrecognized diabetes” patients experience an 18-fold higher mortality then patients without hyperglycemia. There also noted that when people do not have previous history of Diabetes even high level of glucose could be left untreated (Mokshagundam, 2004, p. 137).
There a lot of challenge for a patient to