Lange Anesthesiology > Section IV. Physiology, Pathophysiology, & Anesthetic Management > Chapter 36. Anesthesia for Patients with Endocrine Disease

The Pancreas

"Adults normally secrete approximately 50 U of insulin each day from the cells of the islets of Langerhans in the pancreas. The rate of insulin secretion is primarily determined by the plasma glucose level. Insulin, the most important anabolic hormone, has multiple metabolic effects, including increased glucose and potassium entry into adipose and muscle cells; increased glycogen, protein, and fatty acid synthesis; and decreased glycogenolysis, gluconeogenesis, ketogenesis, lipolysis, and protein catabolism.Diabetes mellitus is characterized by impairment of carbohydrate metabolism caused by an absolute or relative deficiency of insulin or insulin responsiveness, which leads to hyperglycemia and glycosuria. The diagnosis is based on an elevated fasting plasma glucose (> 140 mg/dL) or blood glucose (126 mg/dL). Values are sometimes reported for blood glucose, which runs 12–15% lower than plasma glucose. Even when testing whole blood, newer glucose meters calculate and display plasma glucose. Diabetes has recently been reclassified to include four types (Table 36–2); type I (insulin-dependent) and type II (noninsulin-dependent) diabetes are the most common and well known. Diabetic ketoacidosis (DKA) is associated with type I diabetes mellitus, but there are individuals who present with DKA who phenotypically appear to have type II diabetes mellitus. Furthermore, individuals with an initial diagnosis of type II diabetes mellitus can later develop type I diabetes. Long-term..."