management scheme throughout the operative experience depends largely uponwhether insulin is a usual part of the daily therapy. For non- insulin-dependentclient the possibilities range from being permitted to take the oral antidiabeticagent on the morning of surgery to receiving intravenous fluids. Undermostcircumstances, insulin is not given to the client controlled by diet alone. If thetherapeutic plan is a combination o diet and an oral agent, an intravenousinfusion is started. Whether the oral agent is taken or insulin is given asreplacement for it depends upon the extent of the procedure. Fluids areadministered intravenously, and insulin is given in low dose by slow continuousinfusion.
Hyperglycemic Hyperosmolar Non - Ketotic coma (HHNK)
It develops insteadof ketosis if the client produces insulin that is sufficient to prevent ketone bodiesfrom forming, but inadequate to reduce the hyperglycemia. The glucose thenaccumulates to render the blood hyperosmolar.Management and monitoring are similar to those for the person in ketosis. Theblood volume is restored, and the osmolarity of the blood reduced. Hypotonicintravenous fluids are used, and insulin is given sparingly.
An approach to keeping the blood glucose at physiologic levelshas been through
Pancreatic transplant from anondiabetic donor to a diabetic recipient has been used experimentally.
Insulin delivery devices
Research in development of devices that stimulatepancreatic secretion of insulin to keep the blood glucose in a physiological rangeare exciting. Use of these devices in clinical practice has become reality. Onetype is the
continuous subcutaneous insulin infusion
(CSII), which delivers insulinfrom an external device via a fine nylon cannula into the subcutaneous tissue.These devices are equipped to deliver insulin at two rates---one to match thebasal metabolic level and another at a higher rate to cover mealtime or foodintake.
Potential for Injury
Several factors contribute to the diabetic’s potential for injury. Neuropathic changes can diminish sensation, making the client less awareof injury. Vascular changes can decreased the arterial blood supply, therebydecreasing the body’s ability to heal.
Differents Tests:Glycosylated Hemoglubin
is a blood test that reflects average blood glucoselevels over a period of approximately 2 to 3 months. When blood glucose levelsare elevated, glucose molecules attach to hemoglobin in the red blood cells. The