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Most clinical episodes of hypoglycaemia are insulin-induced episodes in individuals with diabetes. They are probably the major factor preventing insulin-treated patients from achieving the glucose targets needed to prevent diabetic complications. This contribution covers the physiological defences against hypoglycaemia, as well as its epidemiology, clinical features and management.
Diabetes presents several special problems during surgery. The fundamental principle of surgical management in diabetes is that capillary blood glucose is measured regularly and accurately, and that these results are recorded and acted on. Most problems occur because staff have forgotten to measure blood glucose, or because very low values have been ignored or wrongly attributed to faulty meters....
Most cases of clinical hypoglycaemia are insulin-induced episodes in patients with diabetes. Hypoglycaemia is probably the major factor preventing insulin-treated patients from achieving the glucose targets needed to prevent diabetic complications. The incidence of hypoglycaemia reflects the inadequacy of current methods of insulin delivery, which lead to inappropriately high insulin concentrations,...
Diabetes presents several special problems during surgery. Fasting causes particular problems in type 1 diabetes. Such patients need basal insulin to prevent ketosis, and develop hypoglycaemia without additional carbohydrate intake. Fasting is of little significance in type 2 diabetes, unless the patient has received oral hypoglycaemic agents. Metabolic changes include the following. • Increases...
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