Undergo various procedures and surgeries more commonly than their nondiabetic counterparts
Have increased morbidity and mortality rates when acutely compromised or ill
At least a third of perioperative diabetics are unrecognized or untreated before surgery
the physician must be vigilant in the identification of diabetes

Cardiac Consequences
Cardiac compromise must be identified before major surgery and during critical illness
High prevalence of silent ischemia warrants cardiac testing preoperatively
Acute glycemic control results in marked improvement in cardiac survival in diabetics with ACS, MI, and after recent cardiac surgery

Renal Consequences
Diabetes is the leading cause of end-stage renal disease
Leads to hypertension, dyslipidemias, and anemia
Developing acute renal failure after CABG increases mortality rate from 1-2% to 20% with moderate acute renal failure and 60% for patients who require dialysis

Goals of Critical Care
To avoid acute renal failure, leading to dialysis
Limiting hypovolemia
Avoiding nephrotoxins
Judicious use of contrast-based radiographic procedures
To decrease significant risk of aspiration (from autonomic neuropathy, gastroparesis)
Appropriate patient positioning
Use of gastric acid secretion suppressants

Glycemic Control
Multiple recent studies suggest that aggressive glucose control may benefit diabetic pts who are critically ill
Insulin infusions are recommended as a way of glycemic control

Glycemic Control of Diabetic Patient in ICU
CONCLUSION: The use of intensive insulin therapy to maintain blood glucose at a level that did not exceed 110 mg/dl substantially reduced mortality in the ICU and morbidity among critically ill patients admitted to ICU

Continuous Intravenous Insulin Infusion Reduces the Incidence of Deep Sternal Wound Infection in Diabetic patients After Cardiac Surgical Procedures

Hyperglycemia as a Risk Factor for Wound Infections
Hyperglycemia impedes the normal physiologic responses to infections
Periods of hyperglycemia are associated with accelerated nonenzymatic glycosylation of body proteins
C3 component of complement is inactivated and unable to bind to the surface of invading bacteria
Glycosylation of newly synthesized collagen in hyperglycemic animals is associated with increased collagenase activity and decreased wound collagen content
Impaired phagocytosis, delayed chemotaxis, and depressed bacteriocidal capacity
The degree of hyperglycemia that has been shown to impair phagocytic function is as low as 200 mg/dl
Wound healing impairment improves dramatically with control of glucose concentrations

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