الفهرس 
Pathophysiology of Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
P
ediatric patients with diabetes are managed with increasingly complex regimens that have direct implications for their perioperative care. In addition to recognizing the relevant differences among diabetes treatment regimens, pediatric anesthesiologists must also consider a child’s metabolic control, age, size, pubertal development, the intended surgical procedure, and its length when devising a perioperative plan.
As diabetes treatment options for children continue to change, such algorithms will need to be updated. Formal assessment of the impact of such algorithms on clinical outcomes, satisfaction with care, and cost of care would provide additional insight into their revision.
New guidelines has been postulated for the management of diabetic patients throughout surgical interference as tight glycemic control in diabetic patients undergoing major surgery has been shown to improve perioperative morbidity and mortality rates. However, this aggressive strategy requires frequent monitoring of blood glucose concentrations as surgery induces a considerable stress response mediated by the neuroendocrine system through the release of catecholamines, glucagon and cortisol which results in peripheral insulin resistance, increased hepatic glucose production, impaired insulin secretion, fat and protein breakdown and potential hyperglycemia and even ketosis in some cases.
The regimen selected to manage diabetics undergoing surgery has become standardized in most facilities in recent years with a target glucose and maintenance in the range of 80-110 mg/dl but still the key to success of any regimen is careful frequent monitoring to detect any alterations in metabolic control and correct them before they become severe.
Although the mechanism by which to achieve optimal diabetes control in the perioperative period may still be debated, recognition that hyperglycemia may have deleterious short-term as well as long-term consequences highlights the importance of consistently aiming for this goal in the perioperative period just as in the outpatient setting.