Please select a type of Diabetes above to get more information
Day before procedure
Morning of procedure
Hospital pre-operative care
Hospital post-operative care
Patient is safe for discharge home
Post-discharge
Skip breakfastMonitor glucose level on wakingTake usual morning diabetes tablets & injectables
Take usual morning dose of Lantus or Toujeo
Withhold usual dose of rapid-acting insulin eg. Apidra, Humalog, Novorapid
Take ½ of usual dose of pre-mixed insulin eg. Novomix 30, Humalog Mix
Eat a light breakfast by 6am, then skip lunchTake usual morning diabetes tabletsWithhold sulphonylurea
Give ½ the usual morning dose of rapid-acting insulin, then withhold the lunch time doseeg. Apidra, Humalog, Novorapid
Monitor glucose levels before breakfast & after 4 hoursIf glucose level falls <4 mmol/L, treat with one of:
Report the hypoglycaemic event on arrival at hospital
Monitor glucose level on arrivalIdeal perioperative glucose levels are 5 – 10 mmol/L, but levels 4 – 12 mmol/L are acceptableProceed to surgery if glucose levels are 4 – 12 mmol/L
If glucose level is <4 mmol/L, manage hypoglycemia
If glucose level is >12 mmol/L, Step 1: Give a dose of Novorapid, dose = Weight ÷ 10Step 2: Recheck capillary glucose in 1 hour
Monitor glucose levels every 1 hour until patient is eatingWhen patient is eating without vomiting, they can eat and give boluses and resume their usual insulin settings If glucose level is 4 – 15 mmol/L, patient can be safely dischargedIf glucose level is <4.0mmol/L, treat hypoglycemia
If glucose level is >15 mmol/L, treat hyperglycemia Step 1: Give Novorapid bolus, dose = Weight ÷ 10Step 2: Recheck blood glucose level after 1 hour
Refer patient to the Endocrinology team or physician
Resume usual dietRestart usual tablets, injectables and insulin Monitor glucose levels regularly: before breakfast, lunch & dinnerMild hyperglycemia is common for the first few days postoperatively, so aim to:
Eat a light breakfast before 6am, then skip lunchReduce the usual basal rates by 30%Reduce the bolus dose according to the carbohydrate content in breakfast, then withhold the lunch time bolusMonitor glucose levels before breakfast & after 2 hoursIf glucose level falls <4 mmol/L, treat with one of:
Report the hypoglycaemia on arrival at hospital
Monitor patient’s glucose level on arrivalIdeal perioperative glucose levels are 5 – 10 mmol/L, but levels 4 – 12 mmol/L are acceptableProceed to surgery if glucose levels are 4 – 12 mmol/L
Change insulin pump to insulin infusion
Patient to retain pump, insulin cartridges for use post-operatively
If pre-operative glucose level is >12 mmol/L, manage hyperglycemia
Treat diabetic ketoacidosis
Postpone surgery
Proceed to surgery when:
Reschedule surgery
Monitor glucose levels every 1 hour until patient is eatingIdeally, limit the insulin infusion to less than 24 hours
Plan:Resume their usual pump settingsInsert and commence the pump, then switch off the insulin infusion after 2 hours
Lantus once daily, best given mane or bedtime
Rapid-acting insulin is given before meals
Plan:Give the Lantus now and the rapid-acting insulin with the next mealStop the insulin infusion 2 hours after the mealRestart the insulin pump when the patient is ready
Resume usual dietRestart usual insulin pump settings Monitor glucose levels regularly: before and after meals and at bedtimeMild hyperglycemia is common for the first few days post-operatively, so aim to:
Adjust insulin doses if glucose levels are out of range:
Eat a light breakfast by 6am, then skip lunchWithhold all usual diabetes tabletsWithhold exenatide and liraglutide Monitor glucose levels before breakfast & after 4 hoursIf glucose level falls <4 mmol/L, treat with one of:
Monitor glucose level on arrivalIdeal perioperative glucose levels are 5 – 10 mmol/L, but levels 4 – 12 mmol/L are acceptable
When patient returns to the surgical ward for post-operative care, the immediate diabetes management depends on whether patient is on an insulin infusion:
Lantus once daily
Continue insulin infusion until patient is eating without vomitingIdeally, and insulin infusion runs for no longer than 24 hoursChange to a basal bolus insulin regimen as soon as the patient is stable, and eating without vomiting Use a basal bolus insulin regimen during the hospital admission:
If glucose levels are >12 mmol/L after starting insulin:
If your patient’s glucose control is poor pre-admission (HbA1c >8.0%, regular hypoglycaemic events):
If your patient prefers to continue basal bolus insulin regimen at discharge
Resume usual dietRestart usual tablets, injectables Monitor glucose levels regularly: before breakfast, lunch & dinner
Mild hyperglycemia is common for the first few days post-operatively, so aim to:
Preparing for discharge
Skip breakfastMonitor glucose level on wakingWithhold all diabetes tablets Withhold exenatide and liraglutide
Skip mane dose of Lantus, Levemir or Toujeo, as commencing insulin infusion early
Eat a light breakfast by 6am, then skip lunchWithhold all diabetes tablets Withhold exenatide and liraglutide
Take 2/3 of the usual morning dose of Lantus, Toujeo or Protaphane
Take ½ of usual dose of pre-mixed insulin eg. Novomix 30, Humalog MixMonitor glucose levels before breakfast & after 4 hoursIf glucose level falls <4 mmol/L, treat with one of:
Monitor glucose level on arrivalCommence intravenous fluids 4% Dextrose 0.18 Normal Saline, at 125 ml/hour
Ideal perioperative glucose levels are 5 – 10 mmol/L, but levels 4 – 12 mmol/L are acceptableProceed to surgery if glucose levels are 4 – 12 mmol/L
Continue insulin infusion until patient is eating without vomitingIdeally, and insulin infusion runs for no longer than 24 hoursChange to a basal bolus insulin regimen as soon as the patient is stable, and eating without vomiting Use a basal bolus insulin regimen during the hospital admission, regardless of their usual insulin regimen
If glucose levels are >12 mmol/L after the insulin injections were commenced:
If your patient wishes to change back to their usual insulin regimen
If your patient’s glucose control is poor pre-admission (HbA1c >8.0%, regular hypoglycaemic events)
Resume usual dietRestart usual tablets, injectables and insulin Monitor glucose levels regularly: before breakfast, lunch & dinner
