The challenge for the primary care physician and the diabetologist in all diabetic retinopathy patients is to achieve excellent glycemic control, aggressive blood pressure control, and lipid normalization. Diabetic patients are at increased risk for adverse outcomes following surgery for proliferative diabetic retinopathy, which is related to pre-existing diabetes complications, particularly atherosclerotic disease, nephropathy, and peripheral and autonomic neuropathy; similarly, hyperglycemia is associated with a higher risk for poorer wound healing or infections, as well as a possible loss of nutrients through glycosuria. In the postoperative management of most diabetic patients, the use of insulin provides a great deal of flexibility in terms of timing and dose. Short-acting insulin analogs have been shown to be effective as pre-meal medication or as a rapid counteraction to severe hyperglycemia in both outpatients and hospitalized patients.
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