Management of Diabetes during Surgery

Organization

Prepare a local care protocol

Disseminate the protocol to relevant professionals

Management

Optimize blood glucose control pre-operatively ( see also : Blood glucose control assessment levels )
Delay major surgery if possible when
		HbA_1c >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 :
		If diet / oral agents and good blood glucose control and minor surgery :
			omit therapy on morning of surgery
			restart when eating normally ( metformin only after renal function check )
			avoid glucose-containing IV infusions
		If insulin therapy or unsatisfactory blood glucose control or major surgery :
			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 )
Encourage supervised self-management while in hospital

Surgical glucose-insulin-potassium (GIK) regimens
		Use 500 ml 10 % ( 100 g/l ) glucose ( dextrose ) containing :
	unmodified ( soluble, regular ) human insulin 16 U potassium chloride 10 mmol
		Infuse at 80 ml/h from a volumetric pump
		Consider higher dose ( 20 U ) if obese, or initial blood glucose high
		Consider lower dose ( 12 U ) if very thin, or usual insulin dose low
		Adjust dose by 4 U if glucose falling and normal or low
		Adjust dose by 4 U if glucose rising or high
		Continue the GIK infusion until 30-60 min after first meal
		Use higher strength glucose solutions if water volume a problem
		Check for dilutional hyponatraemia daily