| Optimize blood glucose control
pre-operatively ( see Assessing metabolic control above ) |
Delay major surgery if possible when HbA1c
>9.0 % or |
|
 |
fasting glucose >10.0 mmol/l ( >180 mg/dl ), or |
|
|
post-prandial >13.0 mmol/l ( >230 mg/dl ) |
Screen for complications which may affect surgery risk; alert the
surgical team : |
|
|
heart or kidney problems |
|
|
autonomic or peripheral nerve damage |
|
|
proliferative retinopathy |
Manage blood glucose / insulin : |
|
 |
use IV glucose-insulin-potassium infusion ( GIK ) |
|
|
start at 0800 h and continue until eating normally |
|
|
monitor blood glucose before, during, and after ( 1-4 hourly ) surgery |
|
- use a quality-assured method
|
|
|
aim for blood glucose levels of 6.0-10.0 mmol/l ( 110-180 mg/dl ) |
|
|
treat hypoglycaemia with glucose and restart GIK at lower insulin dose |
|
|
never stop intravenous insulin infusions |
|
|
return to normal timing of insulin injections as soon as practicable |
Encourage supervised self-management while in hospital |
