Avoid excess morbidity and mortality
- Hypo, hyperglycemia, increased protein catabolism and undue electrolyte imbalance.
- Aim for a blood sugar around 200mg/dl i.e: (7 to 11 mmol/L)
- More stringent the control, better it is i.e: 110 in post op period
Pre Operative Management
Type 1: start short acting or split insulin. Stop long acting preparations
Type 2: Stop long acting sulphonylureas, substitute with short acting ones. Stop metformin. Stop all oral hypoglycemics on the day of surgery
Peri Operative Management
continued Insulin Pump (IP) infusion or Glucose Insulin Potassium (GIK) infusion.
Minor surgery: just monitor
Major Surgery: manage as type 1
Post Operative Management
- Monitor B.S 1-2 hourly till stable glycemic control and then 4 hourly
- Check Potassium 6 hourly
- IP/GIK continued until pt begins to eat
- Overlap SC insulin for 1 hour with GIK to allow absorption of SC insulin.
- Rx as minor surgery with meticulous control of sugar 1 hourly peri operatively
- Give SC insulin post operatively.
Rx as major surgery with infusion (IP/GIK)
Summary and Conclusion
- Stress increases sugar
- Controlled type 2: hold Rx for minor surgery
- Un controlled type 2 + Type 1 on minor list + Type 1 on major list: Rx with IP/GIK infusion.
- OPD surgery is safe
- Emergency Surgery: good control mandatory before start of surgery
30 units R insulin + 20 mmol K + 1000 ml 20% dextrose @ 100 ml/hour.
15 units R insulin + 20 mmol K + 1000 ml 5% dextrose @ 100 ml/hour.
50 units R insulin + 50 ml 0.9% saline in 50 ml syringe
- 0 – 4 = 0.5 u/hr (recheck in 30 mints)
- 4.1 – 7 = 1.0
- 7.1 – 11.0 = 2.0
- 11.1 – 17.0 = 4.0
- More than 17.0 = 6.0 to 8.0