Surgical complications are minimized if glucose levels are between 5 and 10 mmol/L during the procedure and the first 24 hours postoperatively. Perioperative fasting puts your patient at risk of hypoglycaemia, while the stress of surgery can cause hyperglycemia. Diabetes medication and insulin doses need to be managed carefully to achieve optimal glucose control. These guidelines will help you achieve stable glucose levels for your patient.
These are split into guidelines for:
- Minor Procedures
- These procedures require a minimum period of fasting, meaning that the patient would expect only to miss one meal
- The expectation is that patients will be discharged home on the same day of their procedure
- Major Procedures
- These procedures require a more prolonged period of fasting ie. at least two meals will be missed
- Patients will be admitted to the ward after the procedure
- An insulin infusion is recommended at induction of anaesthesia in patients who:
- Are treated with insulin
- Have out of control glucose levels pre-operatively (<4 mmol/L or >10 mmol/L)
- This is changed to a basal bolus insulin regimen post-operatively when the patient is eating and stable.