Diabetes

Question 1

Type I DM

Answer 1

1. First on morning list
2. Night before - reduce subcut basal insulin by 1/3rd
3. Morning - omit insulin and commence IV variable rate insulin pump
4. dextrose while nill by mouth

Question 2

When to check capillary glucose

Answer 2

Every 2 hours and to alter the infusion rate accordingly

Question 3

When eating and drinking again

Answer 3

Subcutaneous rapid-acting insulin ~20 minutes before a meal and stop their IV infusion ~30-60 minutes after they’ve eaten

Question 4

T2DM

Answer 4

Metformin should be stopped on the morning of surgery

All others should be stopped ~24 hours before the operation

IV variable rate insulin infusion along with 5% dextrose when nill by mouth if poor glycaemic control

Question 5

Basal bolus insulin regime and surgery

Answer 5

Stop actrapid - as fast acting and NBM
Continue lantus at 80% of usual dose - as basal
Start VRIII

Question 6

Restarting basal bolus dose

Answer 6

Stop VRIII 30 mins after lunch and restart basal bolus dose 20 mins before lunch

Question 7

Perioperative mx of diabetic pts

Answer 7

Book first on operating list - minimise hypo risk

Question 8

Sulfonylureas

Answer 8

Omit day of surgery and recommence when pt is eating

Question 9

Metformin

Answer 9

If good renal function and only missing one meal - Metformin can be continued

If more than OD - stop and VRIII

Restart when eating again