Peri‐operative management of the surgical patient with diabetes 2015

Abstract

SummaryDiabetes affects 10–15% of the surgical population and patients with diabetes undergoing surgery have greater complication rates, mortality rates and length of hospital stay. Modern management of the surgical patient with diabetes focuses on: thorough pre‐operative assessment and optimisation of their diabetes (as defined by a HbA1c < 69 mmol.mol−1); deciding if the patient can be managed by simple manipulation of pre‐existing treatment during a short starvation period (maximum of one missed meal) rather than use of a variable‐rate intravenous insulin infusion; and safe use of the latter when it is the only option, for example in emergency patients, patients expected not to return to a normal diet immediately postoperatively, and patients with poorly controlled diabetes. In addition, it is imperative that communication amongst healthcare professionals and between them and the patient is accurate and well informed at all times. Most patients with diabetes have many years of experience of managing their own care. The purpose of this guideline is to provide detailed guidance on the peri‐operative management of the surgical patient with diabetes that is specific to anaesthetists and to ensure that all current national guidance is concordant.

Therapeutic experience of 289 elderly patients with biliary diseases

“…In patients with coexisting diabetes[35,36], surgical stress can cause disorders of glucose metabolism and insulin resistance, and even produce ketone bodies or ketoacidosis. Therefore, the use of oral hypoglycemic agents and intermediate- or long-acting insulin should be stopped and switched to regular insulin.…”

Should blood glucose measurement be a standard of monitoring? A reply

“…We commend Kearns et al for their compelling study demonstrating non-inferiority of spinal morphine to fasica iliaca block (FIB) [1]. We would like to invite the authors to comment on some further questions we have about this paper.…”

“…Centre [1], which was published just before the 5th edition of the standards of monitoring during anaesthesia and recovery guidelines [2]. I accept their point that there is a need for higher awareness on the importance of appropriate and careful management of diabetic patients, and perhaps it was an opportunity missed when we did not include a reference to the diabetic guideline in the standards of monitoring guidelines.…”

The best hypoglycaemia avoidance initiative in the UK

“…We recommend that glucose control during the hospital stay should be more realistic and should aim for levels of 6-10 mmol/L, with a range of 4-12 mmol/L being acceptable for patients on VRIII. 16,17 The American Diabetes Association recommends a target glucose level of 7.8 and 10 mmol/L for all inpatients with diabetes on insulin treatment in general, although lower or higher targets may be necessary in specific circumstances. 18 In patients with previous tight control reflected by HbA1c of 48 or below, extra caution should be exercised.…”