Surgery Definition - What options available for glycemic control in diabetic patient in surgical setting?
The general practitioner should ensure that optimise glycemic control is considered prior to surgery. Diabetic patient is considered first on the list due to avoid any case of prolonged fasting.
In the case of diabetes mellitus type 1,patient need to stop all long acting insulin the night before surgery. Morning subcutaneous insulin should be omitted and change to intravenous insulin based on the sliding scale. Some units advocates GKI regime with 500 ml bags of 5 -10% dextrose, 20 mmol potassium chloride and insulin adjusted every 4 hour according to blood glucose monitoring. This will suppressed the production ketone and provided basal insulin and avoidance of complication in the form of hypoglycemia. Blood glucose is monitored regularly and aiming for normoglycemia. Later switch to regular subcutaneous insulin after patient taken the second meal.
In type 2 diabetes mellitus, if fasting blood glucose monitoring is more than 15, on the morning of the surgery, the patient is treated in the same way as type 1 diabetes mellitus. The day prior to surgery considers halving the dose of sulphonylurea. Morning dose is omitted on the day of surgery. Switch to intravenous insulin sliding scale in the case of major operation where food has not been taken for several days.
In the case of diabetes mellitus type 1,patient need to stop all long acting insulin the night before surgery. Morning subcutaneous insulin should be omitted and change to intravenous insulin based on the sliding scale. Some units advocates GKI regime with 500 ml bags of 5 -10% dextrose, 20 mmol potassium chloride and insulin adjusted every 4 hour according to blood glucose monitoring. This will suppressed the production ketone and provided basal insulin and avoidance of complication in the form of hypoglycemia. Blood glucose is monitored regularly and aiming for normoglycemia. Later switch to regular subcutaneous insulin after patient taken the second meal.
In type 2 diabetes mellitus, if fasting blood glucose monitoring is more than 15, on the morning of the surgery, the patient is treated in the same way as type 1 diabetes mellitus. The day prior to surgery considers halving the dose of sulphonylurea. Morning dose is omitted on the day of surgery. Switch to intravenous insulin sliding scale in the case of major operation where food has not been taken for several days.