Perioperative Management of Diabetes Mellitus

Question 1

Above what level of Hba1c should elective surgery be postponed

Answer 1

> 69mmol/mol, if safe and practical

Question 2

Perioperative Management of- Metformin

Answer 2

Biguanides- reduces hepatic glucose production
Can cause lactic acidosis
CPOC- continue

Question 3

Perioperative Management of- Sulfonylureas

Answer 3

Stimulates B cell insulin secretion
Can cause hypoglycaemia
CPOC- withhold on day of surgery until normal diet resumed

Question 4

Perioperative Management of- Thiazolidinediones (-glitazones)

Answer 4

Decrease insulin resistance
Can cause fluid retention and hypoglycaemia
CPOC- Continue

Question 5

Perioperative Management of- GLP-1 agonists (-glutides)

Answer 5

Stimulate insulin secretion, inhibit glucagon secretion and suppress appetite
Can cause delayed gastric emptying
CPOC- Continue

Question 6

Perioperative Management of- DPP-4 inhibitors (-gliptins)

Answer 6

Stimulate GLP 1 secretion
Can cause delayed gastric emptying
CPOC- Continue

Question 7

Perioperative Management of- SGLT2 inhib (-flozins)

Answer 7

Induce renal glucose excretion
Can cause euglycaemic ketoacidosis and diuresis
CPOC- Withold 48 hours prior to surgery