الفهرس 
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Abstract
The human pancreas secretes 40-50 units of insulin per day in normal adults. The major function of insulin is to promote storage of ingested nutrients. It directly or indirectly affects the function of almost every tissue in the body. Normal insulin sensitivity varies widely and is influenced by age, ethnicity, and obesity.Insulin resistance is a condition where there are defects in the action of insulin. As a result normal levels of insulin do not trigger the signal for glucose absorption. This will lead to hyperinsulinemia to maintain euglycemia. As blood glucose levels rise, impaired glucose tolerance and then type 2 diabetes develops. Diabetes mellitus is an increasingly common endocrine disease that affects people of all ages, resulting in significant morbidity and mortality. The major risk factors for people with diabetes undergoing surgery are the associated end-organ diseases: cardiovascular, autonomic neuropathy, stiff joint syndrome, and immune deficiency. Diabetic ketoacidosis (DKA) is a serious acute complication of decompensated diabetes mellitus. Episodes of DKA occur more commonly in patients with type 1 diabetes and are precipitated by infection or acute stress.
Surgery produces a stress response that can be modified by anaesthetic agents. Furthermore, anaesthetics can affect glu¬cose homeostasis peri-operatively in diabetic patients by decreasing catabolic hormone secretion.
The preoperative assessment of diabetic patients must be meticulous and, in addition to the usual medical history and examination, the type, duration, current treatment of diabetes, and presence of any complications must be established. Many patients with diabetes who require emergency surgery will not be in good metabolic control at that time and may even have diabetic ketoacidosis. These patients must be fully assessed, clinically and biochemically. The first priority is to assess glycemic, acid-base, electrolyte, and fluid status, and correct any derangements before surgery. In most cases, diabetic patients requiring emergent surgery should be managed with an IV infusion of insulin. Surgery should be delayed, if possible, to stabilize metabolic status.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 to detect any alterations in metabolic control and correct them before they become severe.