Care of surgical patient with Diabetes

Question 1

What is the goal HBA1C target for a patient undergoing surgery?

Answer 1

<8.5% or <99mmol/mol

Question 2

What should be pre-prescribed for a diabetic patient?

Answer 2

• Their hypoglycaemic and hyperglycaemic treatment

Question 3

When should their surgery be in the day?

Answer 3

• In the morning

Question 4

When is a VRIII required?

Answer 4

If over 1 meal is missed

Question 5

What is the aimed for CBG during the peri-op period?

Answer 5

6-10mmol/L but 6-12 is acceptable

Question 6

When should CBG be monitored hourly?

Answer 6

• Peri-operatively
• Post-operatively until patient eating and drinking
• First 12 hours of VRIII

Question 7

Which type of diabetes should you never stop VRIII in?

Answer 7

Type 1

Question 8

What is the CBG range for a post operative diabetic patient who is awake and on usual medications?

Answer 8

4-12mmol/l

Question 9

What are the indications for VRIII?

Answer 9

1. T1DM with starvation period greater than 1 missed meal/not recieving background insulin
2. T2DM with starvation period greater than 1 missed meal and hyperglycaemic
3. Patients with HBA1C>8.5%
4. Emergency surgery

Question 10

What is the management of peri-op hyperglycaemia in a patient missing only 1 meal?

Answer 10

1. Check for DKA
2. In type 1 give rapid acting insulin SC (1 unit drops glucose by 3). Check glucose 1hr later.
3. In type 2 give 0.1units/kg of SC rapid acting insulin. Check glucose 1hr later.
4. If hyperglycaemia persists despite 2 doses of PRN novorapid, consider VRIII and consider causes of hyperglycaemia

Question 11

What is the summary of management for a peri-op type 1 diabetic?

Answer 11

1. First in the morning list for surgery, may need to stay overnight.
2. On the night before, reduce basal sc insulin by 1/3.
3. Omit morning insulin and commence VRIII.
4. Whilst NMB, commence 5% dextrose given 125ml/hr.
5. Check CBG every 2hrs.
6. Continue until patient is able to eat and drink. Give SC insulin 20 mins before meal and stop VRIII 30-60 mins after a meal. Overlap them.

Question 12

What is the summary of management for a peri-op type 2 diabetic controlled by diet?

Answer 12

No management

Question 13

What is the summary of management for a peri-op type 2 diabetic controlled by tablets?

Answer 13

1. Stop metformin on day of surgery, stop other medications 24hrs before surgery
2. VRIII started and managed same as T1DM