If you are a diabetic, it is better to have your procedure scheduled early in the day or "first case," especially if your diabetes is difficult to manage.
Many of our patients have diabetes, and if there are other diabetics scheduled in the same room, you may not be the first. For early-morning short procedures where you may still be expected to eat according to your usual meal plan, it is easiest just to take your morning oral medication or insulin and food after the procedure (as if you just got up late that day).
Shortening the intervals between later meals may compensate for this delay and gradually realign your mealtimes back to the usual schedule. This is the easiest for both patients and physicians because it has the least disrupting effect diabetes management.
Multiple factors influence blood glucose management. Specific guidelines will not fit every patient's needs. Consider the following criteria when making decisions with your physician and anesthesiologist about managing your diabetes when you must have a procedure.
Do you have type 1 or type 2 diabetes mellitus? Type 1 diabetics should never have all insulin withheld.
Both types 1 and 2 can occur at any age. Long duration (over 10 years with type 2) usually means greater insulin deficiency and/or greater insulin resistance. Type 1 diabetics can become more resistant to insulin and type 2 diabetics can become insulin deficient.
Overweight people (both types) have more insulin resistance and require larger amounts of insulin for control.
What type/amount/frequency of medication(s) are you taking?
If continuous insulin therapy started within 6 months of diagnosis this usually means severe insulin deficiency or type 1.
Tell your anesthesiologist if you have any complications to help avoid worsening them during procedure. Diabetic feet need protection to prevent pressure ulcers; renal insufficiency means renal blood flow must be protected; renal failure means we need to coordinate with your dialysis schedule; any infection may mean we need to change insulin management.
Blood glucose control, not just a recent blood glucose levels, is important - we like to assess a recent hemoglobin A1c result and possibly your glucose log, then check glucose in pre-operative area.
Are you able to recognize symptoms of low blood glucose and how to treat yourself, or do you need assistance?
Always continue basal insulin source (NPH, Lente, Ultralente, glargine (Lantus), detemir (Levemir), insulin pump or intravenous insulin infusion) in order to prevent ketoacidosis. Serious problems result from a lack of insulin.
Type 1 patients on glargine (Lantus) or detemir (Levemir) can be considered to be on a "poor man's pump" which should be continued without diminishing the dose. Glargine is usually taken every 24 hours at night as a basal dose, does not peak, and is dosed unrelated to food intake. Detemir is usually taken every 12 hours, does not peak, and is dosed unrelated to foot intake.
Dose may need to be adjusted for peaking insulins (NPH, Lente, Ultralente).
Do not take short acting (Regular, Humalog or Novalog) injected insulin the morning of procedure.
If you are treated with continuous insulin infusion therapy (insulin pumps) you may be treated with your usual basal infusion rate.
We may need to involve your endocrinologist or endocrinology consultant if you are considered (or consider yourself to be) a complex or high risk patient.
We may omit all subcutaneous insulin and start an intravenous insulin infusion the morning of the procedure; we have an ICU insulin infusion protocol we can use. Intravenous regular insulin is indicated during the perioperative period for previously insulin-treated patients undergoing long, complex operative procedures; patients who require emergency surgery while in ketoacidosis; and patients with unstable type 1 diabetes.
Omit fast- or rapid-acting injected insulin the morning of procedure.
Follow guidelines for type 1 diabetes above.
Type 2 diabetes patients may be prescribed glargine insulin as a basal dose OR may have a larger dose prescribed (sometimes in morning and evening divided doses) to compensate in part for meals. They may alternatively be on detemir insulin which lasts up to 24 hours but is usually prescribed in twice daily doses.
We may stop all subcutaneous insulin and start intravenous insulin infusion the morning of the procedure.
| Back to Top |