Surgical Complications of DM

Question 1

What happens to BG levels with hospitalization or inflammation?

Answer 1

Cortisol levels increase, causing insulin resistance

Question 2

Can DM be reversed by diet?

Answer 2

Yes

Question 3

What percent of calories should be plant based? What is the actual amount obtained?

Answer 3

80%

12%

Question 4

What is the major difference between ED visits and office visits for DM?

Answer 4

Office visits allow for more time for evaluation

Question 5

Why is the CV exam so important with DM pts?

Answer 5

the biggest comorbidity

Question 6

What is the best question to ask patients to assess mobility/functional status?

Answer 6

Can you walk around the block?

Question 7

What is the MOA of clopidogrel?

Answer 7

ADP inhibitor

Question 8

Over what age is a cardiac risk factor?

Answer 8

70 yo

Question 9

What rhythms are a risk criteria for an MI?

Answer 9

Anything other than NSR

Question 10

What are the three major things to do to workup DM emergently preoperatively?

Answer 10

• Baseline vitals
• EKG
• Blood work

Question 11

What are the four major postoperative issues with DM?

Answer 11

• Infections
• Wound care
• Glucose control
• Gastroparesis

Question 12

What are the two major factors that increase infection susceptibility with DM pts?

Answer 12

• Reduced vascular perfusion

- Increased glucose for pathogens

Question 13

What is the effect of hyperglycemia on the complement cascade?

Answer 13

Inhibition

Question 14

What is the relation between sternal infections and hyperglycemia?

Answer 14

Sugars over 200 mg/dL increased the incidence of sternal wound infections

Question 15

What is the error rate of accuchecks?

Answer 15

10%

Question 16

What is the effect of intensive insulin therapy post op?

Answer 16

Increased mortality

Question 17

What is the BG level that is the goal of post op DM pts?

Answer 17

Less than 180 mg/dL

Question 18

True or false: you usually stop oral DM II drugs prior to surgery?

Answer 18

True

Question 19

What is the major complication of metformin?

Answer 19

Lactic acidosis

Question 20

What are the major side effects of first and second generation sulfonylureas?

Answer 20

Hypoglycemia for both

Disulfiram effect in 1st gen

Question 21

What are the diseases that can prevent absorption of insulin SQ?

Answer 21

sepsis

IVFs

Question 22

What happens to peripheral circulation with sepsis (not shock)?

Answer 22

Vasoconstriction

Question 23

What is the danger of administering SQ and IV insulin?

Answer 23

IV will work now, and SQ can work later when perfusion increases. This is a risk for hypoglycemia

Question 24

What is the major GI effect of DM? What is the effect of this with intubation?

Answer 24

• Gastroparesis

- Increased risk of aspiration

Question 25

What is the MOA of metoclopramide?

Answer 25

D2 receptor antagonist also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist.

Question 26

What are the complications that can arise from post op MI with DM?

Answer 26

PEs | Arrhythmias

Question 27

What is the consequence of fatter liver?

Answer 27

- Decreased metabolism of drugs, even following operation | - Increased risk of cirrhosis

Question 28

What is the effect of DM on contrast-induced nephropathy? How do you prevent this?

Answer 28

High risk Hydrate and give N-acetylcysteine

Question 29

What is the MOA of N-acetylcysteine?

Answer 29

Glutathione donor to protect liver from free radical damage

Question 30

What is Fournier's gangrene?

Answer 30

A horrendous infection of the genitalia that causes severe pain in the genital area and progresses from erythema to necrosis of tissue. Gangrene can occur within hours.

Question 31

What is the treatment for Fournier's gangrene?

Answer 31

Need emergent surgical debridement--abx will not suffice

Question 32

What are the meds that can worsen hyperglycemia in the hospital?

Answer 32

Steroids | TPN

Question 33

What is the effect of DM on the administration of local anesthesia?

Answer 33

May not need anything, or will need to alter dose to prevent nerve damage

Question 34

What should you do if a DM pt has a BG level less than 70 mg/dL prior to a surgery?

Answer 34

Give 100-200 ccs of D5 or D10

Question 35

What should you do if a DM pt has a BG level greater than 250?

Answer 35

Give SQ insulin

Question 36

What should you do if a DM pt has a BG level greater than 70-250?

Answer 36

Give regular IVF

Question 37

What are the inflammatory processes that are downregulated with hyperglycemia? (4)

Answer 37

- Less rolling/adherence - Phagocytosis - Macrophage activation - Complement cascade