By vgreene, 21 February, 2018 Short-acting insulins:3 Don’t give on day of surgery, unless BG >200 mg/dL3
By vgreene, 21 February, 2018 Basal glargine or detemir. Give usual basal insulin day before and day of surgery; though for safety margin, consider ↓ dose by 20% on surgery day, esp if pt under tight control
By vgreene, 21 February, 2018 Plan day before/day of surgery: Specify med adjustments if known DM, specify PO intake:
By vgreene, 21 February, 2018 ✓A1c, screen nearly all pts for hyperglycemia; adjust meds at home1,2 before elective surgery/procedure
By vgreene, 21 February, 2018 If elevated A1c and surgery elective: PCP/endocrinologist manages new hyperglycemia1 or known DM2 for wks/months pre-op if possible, until A1c closer to goal (eg, 8.5% or other goal)
By vgreene, 21 February, 2018 ✓A1c w/in 60-90days of surgery, if known DM. Consider A1c ✓ if BMI >30 or age >40 yo
By vgreene, 21 February, 2018 Consider Endocrine/Diabetes consult for mgmt/ed, esp if BG difficult to control
By vgreene, 21 February, 2018 Schedule f/u (at least by phone): w/in 1wk if insulin started, otherwise w/in 1mo
