Endocrinology and metabolism clinics of North America
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Endocrinol. Metab. Clin. North Am. · Jun 2003
ReviewPerioperative management of type 1 diabetes mellitus.
Clearly, perioperative management of diabetic patients requires thorough preoperative evaluation and planning whenever possible. A firm understanding of the pathophysiology of type 1 diabetes mellitus, the metabolic stress response, and the interactions between various forms of insulin and other variables such as supplemental nutrition and glucocorticoids can greatly assist in achieving a positive outcome. ⋯ It may also be helpful to allow the patient to function as an active decision-maker in the coordination of care, especially because a large percentage of type 1 diabetes patients (particularly those who are on insulin pumps) are well-educated about their disease process and their own physiologic idiosyncrasies. This knowledge can save valuable time and effort toward achieving the ultimate united goal of avoiding perioperative morbidity and mortality by maximizing glycemic control.
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Endocrinol. Metab. Clin. North Am. · Jun 2003
ReviewEndocrine evaluation of patients with critical illness.
Prolonged critical illness has a high morbidity and mortality. The acute and chronic phases of critical illness are associated with distinct endocrine alterations. The acute neuroendocrine response to critical illness involves an activated anterior pituitary function. ⋯ In addition to the illness-induced endocrine alterations, patients may have pre-existing central or peripheral endocrine diseases, either previously diagnosed or unknown. Hence, endocrine function testing in a critically ill patient represents a major challenge and the issue of treatment remains controversial. The recent progress in knowledge of the neuroendocrine response to critical illness and its interrelation with peripheral hormonal and metabolic alterations during stress, allows for potential new therapeutic perspectives to safely reverse the wasting syndrome and improve survival.