Care of surgical patient with Diabetes Flashcards Preview

Surgery > Care of surgical patient with Diabetes > Flashcards

Flashcards in Care of surgical patient with Diabetes Deck (13)
Loading flashcards...
1
Q

What is the goal HBA1C target for a patient undergoing surgery?

A

<8.5% or <99mmol/mol

2
Q

What should be pre-prescribed for a diabetic patient?

A
  • Their hypoglycaemic and hyperglycaemic treatment
3
Q

When should their surgery be in the day?

A
  • In the morning
4
Q

When is a VRIII required?

A

If over 1 meal is missed

5
Q

What is the aimed for CBG during the peri-op period?

A

6-10mmol/L but 6-12 is acceptable

6
Q

When should CBG be monitored hourly?

A
  • Peri-operatively
  • Post-operatively until patient eating and drinking
  • First 12 hours of VRIII
7
Q

Which type of diabetes should you never stop VRIII in?

A

Type 1

8
Q

What is the CBG range for a post operative diabetic patient who is awake and on usual medications?

A

4-12mmol/l

9
Q

What are the indications for VRIII?

A
  1. T1DM with starvation period greater than 1 missed meal/not recieving background insulin
  2. T2DM with starvation period greater than 1 missed meal and hyperglycaemic
  3. Patients with HBA1C>8.5%
  4. Emergency surgery
10
Q

What is the management of peri-op hyperglycaemia in a patient missing only 1 meal?

A
  1. Check for DKA
  2. In type 1 give rapid acting insulin SC (1 unit drops glucose by 3). Check glucose 1hr later.
  3. In type 2 give 0.1units/kg of SC rapid acting insulin. Check glucose 1hr later.
  4. If hyperglycaemia persists despite 2 doses of PRN novorapid, consider VRIII and consider causes of hyperglycaemia
11
Q

What is the summary of management for a peri-op type 1 diabetic?

A
  1. First in the morning list for surgery, may need to stay overnight.
  2. On the night before, reduce basal sc insulin by 1/3.
  3. Omit morning insulin and commence VRIII.
  4. Whilst NMB, commence 5% dextrose given 125ml/hr.
  5. Check CBG every 2hrs.
  6. Continue until patient is able to eat and drink. Give SC insulin 20 mins before meal and stop VRIII 30-60 mins after a meal. Overlap them.
12
Q

What is the summary of management for a peri-op type 2 diabetic controlled by diet?

A

No management

13
Q

What is the summary of management for a peri-op type 2 diabetic controlled by tablets?

A
  1. Stop metformin on day of surgery, stop other medications 24hrs before surgery
  2. VRIII started and managed same as T1DM