Patients will be allocated into two groups of one hundred each based on diabetic and non diabetic status

Group D Diabetic patients n equals one hundred

Group ND Non diabetic patients n equals one hundred

On the day before surgery the patient will be examined in the sitting position and the following indices will be assessed

Body mass index

Inter incisor distance

Neck extension

Neck circumference

Mallampati score

Thyromental distance and sternomental distance

upper lip bite test

Prayer sign

Palm print sign

On the day of surgery doses of anti diabetic agents will be withheld Six hours of fasting will be ensured Morning fasting blood sugar will be measured and an intravenous line will be secured

In the operation theater adequate intravenous access will be confirmed Standard monitoring will be attached Non invasive blood pressure pulse oximetry electrocardiogram and end tidal carbon dioxide will be monitored after intubation

Before induction of anesthesia all patients will receive intravenous glycopyrrolate zero point two milligrams intravenous midazolam one milligram and intravenous fentanyl two micrograms per kilogram Anesthesia will be induced with intravenous propofol one point five to two milligrams per kilogram followed by intravenous atracurium zero point five milligrams per kilogram

Laryngoscopy will be performed after three minutes with the patient head in morning air sniffing position using a standard appropriate sized Macintosh blade

The laryngeal view will be graded according to the Cormack and Lehane classification

The patient trachea will be intubated with an appropriate size endotracheal tube and correct placement of the tube will be confirmed by capnography and chest auscultation

In case of difficulty maneuvers and adjuncts such as external laryngeal manipulation change in head position use of different size or type of laryngoscope blade and intubating bougie will be employed

The outcome measure will be the Cormack and Lehane grading of laryngoscopy