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Surgery and Diabetes

Fasting and Surgery. Stress hormones' catecholamines, glucagon, growth hormone, cortisolIncrease hepatic glucose productionFasting risk of hypoglycaemia anaesthetic danger. Preoperative Assessment. Physically fitGlycaemic control ideally HbA1c <7.5%Consider:Severity and nature of proc

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Surgery and Diabetes

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    1. Surgery and Diabetes Theresa Smyth Nurse Consultant in Diabetes

    2. Fasting and Surgery ‘Stress hormones’ – catecholamines, glucagon, growth hormone, cortisol Increase hepatic glucose production Fasting – risk of hypoglycaemia – anaesthetic danger

    3. Preoperative Assessment Physically fit Glycaemic control – ideally HbA1c <7.5% Consider: Severity and nature of procedure / surgery Type 2 or type 1 – amount of endogenous insulin Current therapy Immediate pre and postoperative fasting blood glucose ideally 7-11mol/ls

    4. Minor surgery or procedures Diet treated type 2 – no change. BGM before and after OHAs omit morning of surgery except: Long acting sulphonylureas (i.e. chlorpropaminde, glibenclamide) omit several days before (may need change in medication) Metformin and radiological contrast – omit for 48 hrs after (normal renal function) Insulin – IV unless very minor (omit am insulin, 1st on list, insulin as soon as recovered)

    5. Major Surgery IV insulin On insulin normally Diabetes control poor Major surgery Lengthy recovery period Postoperative fasting IV insulin via syringe pump and separate glucose infusion. OR: GKI infusion (10 units of soluble insulin, 10mmol potassium chloride and 10% dextrose 1L, 100ml per hour) Must not discontinue until after sc insulin and meal

    6. Monitoring BGM – at lease every 2 hours, hourly if IV insulin Reduced when stable

    7. Bowel Preparation May need clear fluids 24 hours – liase with diabetes centre Replace CHO with sugary fluids Halve insulin dose evening before investigation

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