CPOC: Perioperative Care of People with Diabetes Undergoing Surgery

Question 1

Preoperative Considerations for Patients with Diabetes

Answer 1

• Check Hba1c (If >69 consider optimising if possible)
• Optimise co-morbidities
• Weight management, exercise and smoking cessation
• Plan for diabetic medication management
• Timing of surgery
• Maintain CBG 6-12mmol/L
• Minimise fasting

Question 2

Intraoperative Considerations for Patients with Diabetes

Answer 2

• Aim CBG 6-12mmol/L
• Check blood glucose hourly
• Consider VRII if missing >1 meal

Question 3

Postoperative Considerations for Patients with Diabetes

Answer 3

• Early mobilisation, eating and drinking
• Aim CBG 6-12mmol/L
• Restart normal diabetic medications as soon as able
• Consider early involvement with inpatient diabetic team if issues

Question 4

Indications for starting VRII

Answer 4

• Diabetics missing >1 meal
• T1DM undergoing surgery who have not received their long-acting insulin
• Diabetics having emergency surgery
• Persistent CBG >12mmol/L in the perioperative period
• Hba1c >69mmol/mol

Question 5

Fluid recommendations to run with VRII

Answer 5

5% dextrose/ NaCl 0.45% with 0.15-0.3% KCl

Question 6

Treating hypoglycaemia in the perioperative period

Answer 6

If E&D
- 15-20g of quick acting carbohydrate
- 150ml of fruit juice, 5 dextrose tablets, 4 teaspoons of sugar dissolved in water

If not E&D
150-200ml of 10% dextrose over 15mins

If no improvement after 3x above consider 1mg glucagon