|Management of blood glucose in patients with diabetes during elective surgery|
|JAMA recently published a clinical insight on the management of blood glucose levels in patients with diabetes undergoing elective surgery (here). For the purpose of easy practice, LiTe Biomedical summarized this highlight into a one-sheet. |
1. Preoperative assessment
HbA1c, if >8%, postpone elective surgery;
Blood glucose, if >250mg/dL (13.9mmol/L) with or without metabolic decompensation, postpone elective surgery.
2. Preoperative review of current glycemic control and pharmacotherapy
Give patients written instructions.
3. Adjustment of medications the day before and on the morning of surgery
3.1 General consideration
Surgery should be scheduled early in the morning if possible.
3.2 On the day before surgery
Continue all medications including metformin;
Long-acting basal insulin administered at night should be reduced by 50% to 75%, especially for patients with malnutrition, and renal or hepatic insufficiency.
3.3 On the morning of surgery
For patients with type 1 diabetes:
Do not interrupt basal insulin delivery in order to prevent diabetic ketoacidosis;
No adjustment in the dose of long-acting insulin is required if its current dose is appropriate (no hypoglycemia, or no prolonged fasting).
For patients with type 2 diabetes:
Half the dose of basal insulin is administered;
Half the dose of intermediate-acting insulin is administered;
Short-acting insulin and ant-diabetic medications should be stopped;
For patients treated with pre-mixed insulin preparation whose fasting blood glucose levels are satisfactory, half the basal component dose can be administered as intermediate-acting insulin. If patients have fasting hyperglycemia (>200mg/dL, or 11.1 mmol/L), half the morning dose of pre-mixed insulin can be administered before surgery.
3.4 Blood glucose targets
It is desirable to keep blood glucose greater than 100 mg/dL (5.5mmol/L);
If blood glucose is greater than 180 mg/dL (10mmol/L), rapid-acting insulin should be administered accordingly.
4. During surgery
Monitor blood glucose every 1 to 2 hours;
Maintain blood glucose levels less than 180 mg/dL (10 mmol/L) without hypoglycemia (70 mg/dL or 3.9 mmol/L);
Subcutaneous supplemental doses of rapid-acting insulin or intravenous insulin can be administered.
5. Postoperative management
5.1 Check blood glucose and review intraoperative insulin administration;
5.2 Maintain blood glucose levels at: pre-prandial: 100-140 mg/dL (5.5-7.8 mmol/L);
random: 100-180 mg/dL (5.5-10 mmol/L)
6. Insulin pump
Only used in the research settings.
You can download the PDF version here.