ABSTRACT
It is well recognized, by both patients themselves and their usual advisors, that the treatment of diabetes in hospitalized diabetic patients is often suboptimal. A lack of knowledge of current treatment strategies and lack of familiarity with newer insulins, pen devices and newer hypoglycemic agents by ward staff contributes to substandard care, but can be overcome by the development, distribution and promotion of good treatment protocols, devised by the diabetic team to cover common situations. Many hospitals have now created in-patient diabetic specialist nurses to facilitate this with back-up from the diabetologist to help with more difficult or unusual cases. This is all the more important as many patients undergoing surgery will have diabetes and the metabolic stress of surgical procedures may lead to adverse outcomes if not properly managed. Diabetic patients undergoing surgery are at special risk of hyperglycemia and ketosis, hypoglycemia, perioperative complications such as wound infection, and iatrogenic problems of blood glucose control.
