VALENSI , Paul

Ambulatory surgery can be carried out on a diabetic patient. By using a close organisational and technical approach, it minimises the risk of disequilibrium and allows the patient to return to his (her) previous way of life more quickly. Taking into account the context of this surgery with return home the same day, the objectives are to...

Diabetes mellitus consists of a chronic elevation of blood sugar levels linked to insulin resistance and/or insulinopenia. Its diagnosis is based on a fasting blood glucose level of ≥ 1.26 g/L or, in some countries, a blood glycated haemoglobin (HbA1c) level of > 6.5%. There are several forms of diabetes. Type 2 diabetes (T2D) is the most...

Transition from continuous intravenous insulin infusion administered intraoperatively is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable strategy taking into account the nutritional supply and variable needs for insulin. It reproduces the physiology of a normal pancreas:...

It is necessary to refer a patient to a diabetologist perioperatively in several circumstances. Preoperatively, the patient is referred if diabetes is discovered or if glycaemic disequilibrium is detected (HbA 1c < 5% or > 8%). During the hospital stay, a diabetologist should be consulted if diabetes is discovered, if there is glycaemic...

In diabetic patients undergoing surgery, it is necessary to evaluate how well glycaemic levels are controlled preoperatively. This evaluation assesses glycated haemoglobin (HbA1c) levels and recent capillary blood sugar levels. Treatment adaptation may be necessary before surgery The specific complications of diabetes should be investigated....

Perioperative hyperglycemia (> 1.80 g/L or 10 mmol/L) is associated with increased morbidity (particularly infection) and mortality. It is managed by decreasing blood sugar levels with insulin. Control of blood sugar levels between 0.90 and 1.80 g/L (5–10 mmol/L) helps to avoid hypoglycemia, which is more frequent when strict normoglycemia is...

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