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