 We gaan op de kie van de diabetische patiënt. In de surgical praktie gaan u wat diabetisch of patiënts op de risiko van diabetisch te zien. Ze hebben een hoog rate van complicitie, ongemaat, het is belangrijk om ze goed te kieven. Have een look at dit lectuur. Let's begin dit talk op de diabetische patiënts, by just definding het probleem. In de normaal patiënt, glukoskontrol is heel tijm. Jouw body geef jouw normaal glukkos level in between 60 en 90 mg per deciliter, dat is about 3.3 tot 5 millimals per liter. Just take a milligans per deciliter en multiply it by 0.0555, you'll get millimals per liter. So, if you take someone and you fast them, say at least six hours, and they have a fasting blood glucose of between 100 and 125, that's 5.5 to 6.9 millimals per liter, they would be termed pre-diabetic. And if that fasting patient has a blood glucose level of more than 125 milligrams per deciliter, or 6.9 millimals per liter, they are diabetic. They can be termed diabetic, you can send them for glucose tolerance test. Now these pre-diabetics are sometimes referred to as being glucose intolerant, and remember that can also be yttrogenic. In other words, we can give them catechol amines, we can give them corticosteroids, or we can give them parenteral glukkos, and it might also make a patient glukkos intolerant, so that can be yttrogenic. The true diabetic though, we define two types, so type one, now these patients are insulin insufficient, they don't produce enough insulin, they've got problems with their beta cells, and then type two, which is the insulin resistant, they might make enough en appropriate insulin levels, they are just resistant to that, and we see that usually in the obese population. Now American literature, we have good databases there, and in most areas you can find that up to 1 in 10 patients are at least are diabetic, and about 50% of them are sometimes unaware of the fact. Up to a quarter are even pre-diabetic, en about 60% to 70% of them can go on to develop diabetes, so it's a huge problem. Now usually you're going to go to a new unit, you don't have to develop a diabetic protocol all on your own, there is usually an existing one, usually based on good evidence and good experience. Be familiar with that protocol, it's the norm for people taking care of the surgical part of patients not to be so familiar with the care of a diabetic patient, so always consult your medical colleagues and your anesthetic colleagues, look at what is done at your institution.