Diabetes

Question 1

What should the HbA1c aim be before elective surgery?

Answer 1

<69mmol/mol

Question 2

What is the standard diabetic pre-op management for insulin-dependent diabetes mellitus?

Answer 2

1. Place first on list (minimise fasting period)
2. Give all usual insulin the night before.
3. Long-acting insulin continued at normal times even when on VRIII
4. If on AM list, no short acting/mixed in the morning.
5. If on PM list, normal morning bolus/half mixed insulin.
6. Omit all rapid acting when on VRIII
7. Start VRIII 2hr before surgery - aim 6-10mmol/L, check glucose every 2hr.
8. When ready to eat, give bolus and stope VRIII 30-60min later.

Question 3

What is the standard diabetic pre-op management for non-insulin-dependent diabetes mellitus?

Answer 3

1. Give usual medication the night before (except sulphonylurea).
2. If eating post-op - AM list, omit morning meds and take with next meal.
3. If not eating post-op - start VRIII 2hr prior to surgery.
4. IV contrast - if on metformin and eGFR <60, omit for 48hr after contrast, if eGFR >60, fine to keep on metformin.