Diabetes mellitus: anaesthetic management.

As the incidence of diabetes mellitus continues to increase in the United Kingdom, more diabetic patients will present for both elective and emergency surgery. Whilst the underlying pathophysiology of type 1 and type 2 diabetes differs, there is much good evidence that controlling the blood glucose to < or = [corrected] 10 mmol.l(-1) in the peri-operative period for both types of diabetic patients improves outcome. This should be achieved with a glucose-insulin-potassium regimen in all type 1 diabetics and in type 2 diabetics undergoing moderate or major surgical procedures. After surgery, a decrease in the catabolic hormone response resulting from good analgesia and the avoidance of nausea and vomiting should allow early re-establishment of normal glycaemic control.