Diabetes perioperative care

Question 1

what do you try to do for any diabetic patient going in for an operation?

Answer 1

get them an early morning procedure

Question 2

what is the main problem with diabetic patients going for surgery?

Answer 2

they need to fast. however this runs the risk of hyperglycaemia and ketosis

Question 3

how do we usually manage the insulin for insulin dependent diabetic patients about to go for surgery

Answer 3

maintain basal dose of insulin but withhold bolus short acting insulin. If required, intravenous insulin and glucose can be given

Question 4

post operative care for a diabetic patient?

Answer 4

Patients should not be allowed to leave hospital until they are able to tolerate food and oral fluids, and they must have an emergency number to ring for advice about their diabetes control over the next 24 to 48 hours.

Question 5

for a long laborious operation such as CAGS, what is needed for a type 1 diabetic?

Answer 5

an intravenous short acting insulin line going to the diabetic patient. This is given in conjunction with IV glucose

Question 6

when should subcutaneous insulin be started again for a type 1 diabetic?

Answer 6

Subcutaneous basal insulin should be started at least one hour before cessation of the intravenous infusion. This avoids a period of absolute insulin deficiency before the long-acting insulin takes effect.

Question 7

what should we do with metformin on the day of the operation? when do we restart metformin?

Answer 7

withhold on day of surgery. Recommence when kidney function is returned

Question 8

what should we do with sulfonylureas and DPP4 inhibitors on the day of the operation?

Answer 8

withhold on day of surgery