Preoperative Assessment in Diabetic

Patients
The mainstay of preoperative assessment in diabetic patients is thorough
history and physical examination. In patients with known DM, the
standard preoperative assessment should include following details:
1.
2.
3.
4.
5.

Details of current diabetes management

Duration of treatment
Specific medication regimen
Issues with insulin resistance or hypersensitivity
Any features of organ involvement

History:
History should assess for symptoms of cardiac, renal, retinal,
neurologic and peripheral vascular disease. History should include :
1. Suggestive symptoms ( eg. polyuria, polydipsia, blurred vision)
2. Eating patterns, nutritional status, exercise history and weight
history
3. Current treatment of diabetes, including medication regimen, diet,
exercise and glucose monitoring results.
4. Frequency, severity and etiology of acute complications ( eg.
Ketoacidosis, hypoglycaemia.)
5. Previous or current infections ( eg. Skin, foot, dental, genitourinary)
6. Symptoms and treatment of chronic microvascular or macrovascular
complications ( eg. eye, kidney, nerve, genitourinary,
gastrointestinal, heart, peripheral vascular and cerebrovascular
complications)
7. Nondiabetic medications that may affect blood glucose levels ( eg.
corticosteroids)
8. Risk factors for atherosclerosis ( eg. smoking, hypertension, obesity,
dyslipidemia, family history)
9. History and treatment of other conditions ( eg. endocrine and eating
disorders)
10.
Family history of DM and endocrine disorders.
11.
Lifestyle, cultural. psychological and economic factors that
might influence DmM management.
12.
Tobacco,alcohol and controlled substance use.
Physical Examination:
A thorough physical examination should be done with specific focus on
the function of the systems involved in diabetes. Various tests for
autonomic neuropathy especially orthostatic hypotension should be
looked for.

Evaluation for difficult intubation should be done by checking for the

mobility at temperomandibular , atlanto- occipital, and other cervical
spine joints as these patients may have stiff joint syndrome limiting
mobility at these joints making intubation difficult. Also difficult
intubation can be predicted by Prayers sign i.e an inability to
approximate the palmer surfaces of the phalangeal joints while
pressing the hands together. These joint changes are mainly due to
chronic hyperglycemia and nonenzymatic glycosylation of collagen and
its deposition in joints.
Further airway evaluation should include assessment of thyroid gland
size as patients with type I DM have 15% association of other
autoimmune diseases such as Hashimotos thyroiditis and Graves
disease.
The degree of preoperative neurologic dysfunction is important to
document specially before the administration of regional anaesthesia
or peripheral nerve blocks to assess the degree of subsequent nerve
injury.
To summarize the physical examination should include:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Blood pressure ( including orthostatic hypotension)

Fundoscopic examination
Airway examination
Thyroid palpation
Cardiac Examination
Evaluation of pulses by palpation
Feet examination
Skin examination ( insulin injection sites)
Neurologic examination

Investigations:
Following basic investigations are must in a diabetic patient:
1.
2.
3.
4.
5.
6.

Blood glucose levels ( fasting and postprandial)

Urinalysis for microalbuminuria and ketones
Complete blood count
Blood urea and creatinine
Serum electrolytes
ECG

In addition to this if we are suspecting any organ involvement we

should investigate accordingly.