Diabetes perioperative management is a critical component of anesthesia care, as poor glycemic control significantly increases the risk of surgical and anesthesia-related complications. Patients with diabetes mellitus, whether type 1, type 2, or gestational, are more vulnerable to infections, delayed wound healing, cardiovascular instability, electrolyte disturbances, and perioperative hypoglycemia or hyperglycemia. Anesthesia planning for diabetic patients must therefore focus on maintaining metabolic stability while minimizing physiological stress.

Surgical stress triggers hormonal responses that raise blood glucose levels through increased cortisol, catecholamines, and glucagon secretion. At the same time, fasting, altered medication schedules, and insulin adjustments increase the risk of hypoglycemia. Both extremes of glucose imbalance can be dangerous, leading to arrhythmias, neurological impairment, infection, and delayed recovery. Anesthesiology teams aim to maintain glucose levels within a safe target range throughout the perioperative period.

Pre-anesthesia assessment includes evaluation of diabetes type, duration, glycemic control, medication regimen, presence of complications such as neuropathy, nephropathy, retinopathy, or cardiovascular disease, and history of hypoglycemic episodes. Insulin-dependent patients require individualized perioperative insulin plans, while those on oral hypoglycemic agents may need medication adjustments to reduce risk.

Intraoperative management emphasizes regular blood glucose monitoring and appropriate insulin or glucose administration. Anesthetic drugs are selected to minimize metabolic disruption and cardiovascular stress. Fluid management is carefully balanced, particularly in patients with diabetic kidney disease or cardiac complications.

Postoperatively, glycemic control remains essential to reduce infection risk and promote wound healing. Pain, nausea, and reduced oral intake can complicate glucose management, requiring close monitoring and adjustment of insulin or medications. Early mobilization and effective pain control further support metabolic stability.

Through structured perioperative planning and multidisciplinary coordination, anesthesia teams ensure safe surgical care and improved outcomes for patients living with diabetes.