New insulin analogues and insulin delivery devices for the perioperative management of diabetic patients.

PURPOSE OF REVIEW

With the rising incidence of diabetes mellitus in the United States today, more and more patients with this comorbidity will present for surgical or interventional procedures. Treatments are becoming more varied and complex so anesthesiologists must be familiar with new drugs and delivery modalities used in the treatment of this patient population.

RECENT FINDINGS

New types of insulin have revolutionized diabetic care. The introduction of rapid acting and long acting insulin has enabled more precise glucose control to be achieved. New delivery modes of insulin both by the inhaled/buccal route and premeasured pen have been introduced. The newer oral hypoglycemic agents are also in use and have mechanisms of action that differ from the older treatments.

SUMMARY

Anesthesiologists must keep themselves updated with the rapidly changing treatment options for diabetic patients with both type 1 and type 2 diseases. The mechanism of action and duration of newer drugs are important for clinicians to know when managing intraoperative serum glucose control.