- See:
General Orders
- Effects on Musculoskeletal System:
- diabetic foot pathology:
-
vascular pathology:
-
diabetic charcot foot and ankle:
-
neuropathic ulceration:
- diabetic osteomyelitis
- experimental evidence that suggests that gram positive bacteria thrive in hyperglycemic state and
that gram negative bacteria grow less well in a hyperglycemic serum;
- this may explain why diabetic patients are more prone to staph infections;
- diabetic skeletal muscle necrosis: (tumoriform focal muscular degeneration);
- Management of Hyperglycemia:
antidiabetic agents
DKA
hyperosmalar non ketotic coma
insulin iv infusion
sliding scale
types of insulin
- preop insulin management:
- 1 unit of insulin disposes of about 8 gm of glucose;
- 1 unit of glucose should decrease blood glucose by about 50;
- most operative patients can be maintained in the 120 to 180 blood glucose range w/ regular insulin infusion rate set at 1.0 unit/hour and 2.0 U/hour;
- note: make the distinction between IDDM and NIDDM
- IDDM: pt must receive insulin on a routine schedule and must not be be placed solely on a
sliding scale;
- NIDDM: pt may be placed solely on
Sliding Scale;
- Diabetic Hypertensive Patient:
-
Ca channel blockers may adversely affect Insulin secretion;
-
Diuretics and
Beta blockers also have problems;
- Consider ACE to be the 1st choice for therapy;
American Association of Clinical Endocrinologists
Centers for Disease Control
First Aid Manual - 1
First Aid Manual - 2
Iowa Family Practice Handbook - 1
Iowa Family Practice Handbook - 2
Merck Manual
References
Hyperglycemia in the Hospital Setting.
