Diabetic Patients

Question 1

What effects does diabetes have on anaesthesia?

Answer 1

Hypo/hyperglycaemia
Glycosylation of ligaments - stiff c-spine
Autonomic dysfunction
Increased risk of surgical site infection

Question 2

What is the effect of starvation?

Answer 2

Catabolic state

Increases blood glucose

Question 3

What is the ideal blood glucose for surgery?

Answer 3

6-10 mmol/L

Question 4

What is a VRIII?

Answer 4

Variable rate intravenous insulin infusion

• 1 iu/ml of actrapid at variable rate depending on glucose
• provide glucose substrate to avoid catabolic state + ketogenesis
• maintain electrolytes (Na/K)

Question 5

What do patients on metformin need to do?

Answer 5

Normal day before

AM surgery - omit if NBM
PM surgery - take

Question 6

What do patients on acarbose need to do?

Answer 6

Normal day before

AM surgery - omit if NBM
PM surgery - take

Question 7

What do patients on sulphonylureas need to do?

Answer 7

Normal day before

Take 1 per day = omit

Take 2 per day
AM surgery - omit morning dose
PM surgery - omit both

Question 8

What do patients on once daily insulin need to do?

Answer 8

Reduce by 20% day before

Check glucose on admission

Question 9

What do patients on 3-5 insulin injections need to do?

Answer 9

Normal day before

AM surgery - omit
PM surgery - take morning dose as normal