The number one priority for Dex is patient safety.
Diabetic patients should follow the advice of their endocrinologist and anaesthesiologist at all times.
Dex should be used with caution in diabetic patients.
Note: Dex is not contraindicated in diabetic patients but should be used with caution. A number of institutions provide Dex to diabetic patients under the guidance of anaesthesiology. Type 1 diabetic patients (including those with an insulin pump) are capable of adjusting their insulin according to the carbohydrate load. We are aware of this practice but our position for simplicity and safety is to recommend excluding all diabetic patients from taking Dex.
Conflicting information does exist in the literature:
A concern for anaesthesiologists is that diabetic patients are expected to be at risk of hyperglycaemia and pulmonary aspiration if there is coexisting autonomic neuropathy18. Gustafsson et al. found that in type 2 diabetic patients, a carbohydrate preload with paracetamol (the latter to determine gastric emptying) was not associated with a delay in gastric emptying, nor a risk of hyperglycaemia or pulmonary aspiration19.