| Title | Perioperative care of the geriatric patient with diabetes or hyperglycemia. | | Author(s) | Maynard G, O'Malley CW, Kirsh SR | | Institution | Division of Hospital Medicine, University of California, 200 West Arbor Drive 8485, San Diego, CA 92130, USA. gmaynard@ucsd.edu | | Source | Clin Geriatr Med 2008 Nov; 24(4):649-65, viii. | | MeSH | Aged
Aged, 80 and over
Diabetes Complications
Diabetes Mellitus, Type 2
Female
Humans
Hyperglycemia
Insulin
Perioperative Care
| | Abstract | The incidence of diabetes in the geriatric population is increasing and the resulting co-morbidities have led to corresponding increases in hospital admissions and surgeries. The weight of the evidence and national guidelines should dissuade us from allowing uncontrolled hyperglycemia in the geriatric perioperative population, but the glycemic target should be modified upwards based on the individual patient characteristics, and in environments that do not have an established track record of reaching more aggressive targets safely. Insulin is the most effective and flexible regimen to achieve inpatient glycemic control, whether by infusion or by subcutaneous basal bolus regimens. Strategies for safe and effective dosing and adjustment of insulin regimens, and methods to avoid hypoglycemia in the perioperative period are outlined. Finally, discharge planning should take into consideration a patient's HbA1c, preoperative glycemic control, inpatient glycemic regimen and control, financial and physical limitations, social support, co-morbid medical conditions, episodes of hypoglycemia, and overall prognosis to create an individualized safe and effective medication regimen for optimal glycemic control at home. | | Language | eng | | Pub Type(s) | Case Reports
Journal Article
Review
| | PubMed ID | 18984379 |
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