Colonoscopy peri-operative management of diabetic patient

Question 1

A 70 year old man is booked for an elective colonoscopy because of a positive faecal occult blood test. He is diabetic and takes metformin but no insulin. He has mild renal impairment with a serum creatinine 0.14mmol/L, (0.06-0.12). How would you assess and manage this man peri-operatively?

Answer 1

Introduction
My peri-operative management can be broken down intro pre, intra, and post-operative assessment and management. The main issues to address for this patient include;
- managing and ensuring no worsening of kidney function
- Specific diabetic management and BSL control
- General colonoscopy considerations

Question 2

Colonoscopy peri-operatively - Pre-op

Answer 2

Pre-op
History
- diabetes history: confirm T2DM 
- current diabetes management
- ensure good diabetes control
- establish if long-term kidney function derangement or AKI (if acne then consider delay of procedure, renal consult)

Procedure

• book morning op to minimise BSL derangements
• choose most appropriate bowel-prep (Moviprep as less electrolyte derangements)
• Only liquid diet for 24 hrs pre-procedure, cease metformin night before procedure given fasting state to prevent hypoglycaemia during operation, may have to reduce insulin depending on dosing, or utilise a sliding scale
• case SGLT2 multiple days prior to procedure
• Check VBG, BSL, UEC on admission

Question 3

Colonoscopy peri-operatively - Intra-op

Answer 3

Intra-op

• IV fluids during procedure
• otherwise normal protocols (time-out, consent etc etc)

Question 4

Colonoscopy peri-operatively - Post-op

Answer 4

Post-op
Diabetes
- monitor BSL post-surgery
- restart metformin with normal doses once begun eating again
- counsel on closer monitoring of sugars over the next few days

Colonosocpy

• assess in recovery for any complications:
• usually can be discharged same day