Features of postoperative therapy in patients with type ІІ diabetes

Abstract

Type 2 diabetes mellitus (DM) is one of the most common diseases in the world. According to data of the International Diabetes Federation, there are more than 425 million people suffering from this disease in the world. The course of type II DM is accompanied by a progressive lesion of the macrovasculature, which is associated with an increase in the risk of developing atherosclerosis in this category of patients by 4-5 times in comparison with patients without diabetes. This in turn leads to some complications such as blindness, strokes, vascular damage of the limbs and chronic renal failure (CRF), which is often the leading cause of death. The occurrence of any inflammatory process against the background of diabetes is a significantly aggravating factor for the patient, as the body’s reserves are reduced, especially in the presence of CRF. The need for urgent surgical intervention in a patient with an inflammatory process against the background of diabetes is another stress factor. In addition, patients with DM are constantly taking hypoglycemic drugs, the effect of which in a stressful situation is not always predictable for the patient and therefore these drugs should be canceled. However, if the patient has CRF and long-term administration of drugs, their effect does not immediately stop. The combination of all the above points puts the patient with DM at a high risk group for the development of serious complications requiring intensive care (IT). Such complications in the early postoperative period may be lactic acidosis, persistent hypoglycemia, electrolyte disorders, cerebral edema. In the clinical case the pathogenesis of the development of these conditions and IT methods are described. Conclusions have been drawn regarding the need for close attention of anesthetists and intensive care physicians during perioperative therapy in patients with DM, complicated CRF, and which are receiving metformin.