Perioperative Diabetes

Question 1

What metabolic changes occur in surgery/acute illness? Why might you want to control these?

Answer 1

• Insulin depression, hyperglycaemia
  
  • Increases infection risk, dehydration, decreases wound healing

Question 2

What questions might you ask a patient with diabetes before surgery regarding their diabetes? What complications are you particularly on the lookout for?

Answer 2

• Diabetes
  
  • How long, what type, BGL control (require HbA1c <8.5% before surgery)
• Complications
  
  • CV risk? May require revascularisation
  • Neuropathy - injury risk during surgery, silent MI
  • Joint stiffness - difficulty intubating

Question 3

How would you manage a patient with T1 diabetes pre/peri-operatively?

Answer 3

• Regular BGL monitoring and correction
• Morning surgery
• Take long-acting insulin
• Withold spike insulin
• 5% dextrose IV 100mL/hour

Question 4

How would you manage a patient with T2D pre/peri-operatively?

Answer 4

• Morning surgery
• Regular BGL monitoring
• Withold metformin 1-2 days pre-op
• Withold sulfonylureas 2 days pre-op