Peri-operative Diabetes Mangement

Question 1

How should patients with DM be managed peri-operatively if they are undergoing major cardiac surgery/CABG?

Answer 1

IV insulin infusion with target BG 5.5 to 11.1

Question 2

How should patients undergoing minor/moderate surgeries be managed in the perioperative period?

Answer 2

Perioperative BG target of 5-10

Question 3

When should IV insulin be used in the peri-operative period for T1DM patients?

Answer 3

For any Type I DM patient where the procedure is > 1-2 hrs.

Question 4

How do you manage the non-insulin DM agents in the perioperative period?

Answer 4

GLP1 - Hold injection day of surgery.
Oral Agents - Hold morning of OR
SLGT2 Inhibitors - Hold 2d before surgery

Question 5

How do you manage long acting insulin and NPH in the perioperative period?

Answer 5

Give 2/3 the usual dose the night before or morning of, depending on when they take it.