Endocrine: Diabetes, surgery and medical illness Flashcards
Patients usually treated with insulin who have good glycaemic control (HbA1c less than __mmol/mol or __ %) and are undergoing minor procedures, can be managed during the operative period by adjustment of their usual insulin regimen, which should be adjusted depending on the type of insulin usually prescribed, following detailed local protocols.
Patients usually treated with insulin who have good glycaemic control (HbA1c less than 69 mmol/mol or 8.5 %) and are undergoing minor procedures, can be managed during the operative period by adjustment of their usual insulin regimen, which should be adjusted depending on the type of insulin usually prescribed, following detailed local protocols
For elective surgery - minor procedures in patients with good glycaemic control: on the day before surgery, the patient’s usual insulin should be given as normal, other than what?
Once daily long-acting insulin analogues, which should be given at a dose reduced by 20%
For elective surgery - minor procedures in patients with good glycaemic control: On the day before the surgery, the patient’s usual insulin should be given as normal, other than once daily long-acting insulin analogues, which should be given at a dose reduced by
Once daily long-acting insulin analogues, which should be given at a dose reduced by 20%
Patients usually treated with insulin, who are either undergoing major procedures (surgery requiring a long fasting period of more than one missed meal) or whose diabetes is poorly controlled, will usually require what to control their diabetes?
Patients usually treated with insulin, who are either undergoing major procedures (surgery requiring a long fasting period of more than one missed meal) or whose diabetes is poorly controlled, will usually require a variable rate intravenous insulin infusion (continued until the patient is eating/drinking and stabilised on their previous glucose-lowering medication).
For elective surgery - major procedures or poor glycaemic control, the aim is to achieve and maintain glucose concentration within the usual target range of what?
6-10mmol/litre; but up to 12mmol/litre is acceptable
For elective surgery - major procedures or poor glycaemic control, the aim is to achieve and maintain glucose concentration within the usual target range (6–10 mmol/litre; but up to 12 mmol/litre is acceptable), how is this done?
By infusing a constant rate of glucose-containing fluid as a substrate, while also infusing insulin at a variable rate.
On the day before major elective surgery or where there is poor glycaemic control, once daily long-acting insulin analogues should be given at what %?
80% usual dose - all other insulin given as normal
On the day of surgery and throughout the intra-operative period, once daily long-acting insulin analogues should be continued at 80% of the usual dose; what should happen to all other insulin?
Stopped until the patient is eating and drinking again after surgery.
on the day of surgery, start an intravenous substrate infusion of potassium chloride with glucose and sodium chloride (based on serum electrolytes which must be measured frequently), and infuse at a rate appropriate to the patient’s fluid requirements. What must happen to prevent hypoglycaemia?
To prevent hypoglycaemia, this infusion must not be stopped while the insulin infusion is running;
a variable rate intravenous insulin infusion of soluble human insulin in sodium chloride 0.9 % (made either according to locally agreed protocols or using prefilled syringes) should be given via a syringe pump at an initial infusion rate determined by what?
bedside capillary blood-glucose measurement
intravenous glucose 20 % should be given if blood-glucose drops below __mmol/litre, and blood-glucose checked every hour, to prevent a drop below __mmol/litre. If blood-glucose drops below __ mmol/litre, intravenous glucose 20 % should be adjusted and blood-glucose checked every 15 minutes, until blood-glucose is above __ mmol/litre (testing can then revert to hourly).
intravenous glucose 20 % should be given if blood-glucose drops below 6 mmol/litre, and blood-glucose checked every hour, to prevent a drop below 4 mmol/litre. If blood-glucose drops below 4 mmol/litre, intravenous glucose 20 % should be adjusted and blood-glucose checked every 15 minutes, until blood-glucose is above 6 mmol/litre (testing can then revert to hourly).
Ketones should be checked and consider other signs of diabetic ketoacidosis if blood glucose rises above what value?
12
Previous subcutaneous basal-bolus regimens, should be restarted when?
The first postpoperative meal-time insulin dose is due (e.g. with breakfast or lunch); doses may need adustment due to postoperative stress, infection or altered food intake.
What antidiabetic drugs can be continued as normal during an insulin infusion for a patient during surgery?
When insulin is required and given during surgery, acarbose, meglitinides, sulfonylureas, pioglitazone, dipeptidyl peptidase-4 inhibitors (gliptins) and sodium glucose co-transporter 2 inhibitors should be stopped once the insulin infusion is commenced and not restarted until the patient is eating and drinking normally. Glucagon-like peptide-1 receptor agonists can be continued as normal during the insulin infusion
Why should SGLT2 be omitted on the day of surgery and not restarted until the patient is stable?
Their use during periods of dehydration and acute illness is associated with an increased risk of developing diabetic ketoacidosis.
