By vgreene, 21 February, 2018 ✓BG: prior to anesthesia induction or incision, upon awakening, and on transfer to post-op. For longer surgeries, ✓BG q1h, esp if on insulin drip
By vgreene, 21 February, 2018 Pre-op: Day of surgery ✓BG q1-2h. ✓A1c1,2 (w/in last 60-90days). Target BG 100-180 mg/dL
By vgreene, 21 February, 2018 Treat hyperglycemia w/ IV or SC insulin; specify plan for hypoglycemia (
By vgreene, 21 February, 2018 For long procedure requiring prolonged NPO: Use IV insulin drip. If T1DM or T2DM on insulin as outpt, use insulin drip maintained @ 1-2 units/h5 w/ D5W at 50-75 cc/h, to maintain BG target3
By vgreene, 21 February, 2018 For short procedure: Use SC insulin; may continue insulin pump4 use (eg, for T1DM or pregnant pts)
By vgreene, 21 February, 2018 Insulin regimen: If on home long-acting basal insulin, give 75%-100% of basal dose; for intermediate-acting and fixed-combo insulins, give 50%-75% of usual dose (50%-67% for NPH)
By vgreene, 21 February, 2018 Hold oral and noninsulin injectable antihyperglycemics (though research isn’t strong). Hold short-/rapid-acting insulins (unless BG >2003)
By vgreene, 21 February, 2018 ✓BG on arrival to pre-op. For hyperglycemia: If A1c reasonable (eg, stress hyperglycemia) OK for OR, after hyperglycemia controlled w/ correction insulin and BG monitoring q1-2h. If markedly high A1c: @ risk for impaired healing, consider deferring
By vgreene, 21 February, 2018 T2DM pts: Guidelines suggest not taking oral antihyperglycemics and noninsulin injectables on day of surgery, though research not strong
