Diabetes and hormonal changes in the perioperative period

The advance of modern anesthesiology, perioperative endocrinology, and Brazilian clinical medicine has provided a detailed understanding of the complex endocrine and metabolic responses triggered by surgical stress in the human body. The surgical procedure and anesthesia induce an adaptive systemic neuroendocrine response to trauma, characterized by the robust activation of the sympathetic nervous system and the massive release of counter-regulatory stress hormones, such as cortisol, glucagon, adrenaline, and growth hormone (GH). In patients with diabetes mellitus, the emergence of this hormonal storm acts as a highly destabilizing pathophysiological factor in the daily medical-surgical routine of the country. Although metabolic regulation in healthy individuals bypasses these fluctuations through a compensatory increase in endogenous insulin, the secretory inability or exuberant insulin resistance observed in diabetics results in severe glycemic spikes, perioperative diabetic ketoacidosis, hyperosmolar state, or dangerous episodes of iatrogenic hypoglycemia. Given the urgent need to consolidate Brazilian scientific evidence on the propedeutic characterization and specific perioperative management protocols within the national epidemiological scenario, this study aims to analyze and synthesize, through a systematic review of the Brazilian medical and biomedical literature, the relationship between diabetes and hormonal changes in the perioperative period. To fulfill this purpose, a structured methodological survey based on the PRISMA protocol was conducted in the SciELO, LILACS, and PubMed electronic databases for original Brazilian articles and national consensus published in the last decade (2016-2026). The results reveal that the hypersecretion of cortisol and catecholamines induces acute hepatic and peripheral insulin resistance, suppresses the translocation of the GLUT4 transporter in muscle tissue, and stimulates gluconeogenesis, while the inadequate suspension of hypoglycemic agents (such as SGLT2 inhibitors) drastically increases the risk of euglycemic ketoacidosis. It is concluded that continuous capillary blood glucose monitoring and the timely institution of intravenous insulin infusion protocols in intensive care or surgical wards in secondary and tertiary care within the Unified Health System constitute essential preventive interventions to avoid surgical site infections, delayed healing, and cardiovascular complications, qualifying the functional survival of the operated population throughout the national territory.(AU)