Endocrinology Book

Diabetes Mellitus

  • Perioperative Diabetes Management

Obesity

http://www.fpnotebook.com/

Perioperative Diabetes Management

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  1. See Also
    1. Preoperative Examination
    2. Deep Vein Thrombosis Prevention
    3. Perioperative Anticoagulation
    4. Endocarditis Prophylaxis
    5. Postoperative Nausea and Vomiting Prevention
  2. Preoperative Evaluation
    1. Cardiovascular risk
      1. See Preoperative Cardiovascular Evaluation
      2. See Perioperative Cardiovascular Risk
      3. Preoperative stress testing is often indicated
      4. Assess for cardiac Autonomic Dysfunction
        1. Risk of perioperative hypotension
        2. Features
          1. Resting tachycardia
          2. Orthostatic Hypotension
          3. No variation in Heart Rate with respirations
        3. References
          1. Burgos (1989) Anesthesiology 70:591
    2. Renal insufficiency (Diabetic Nephropathy)
      1. Renal Function tests
      2. Consider 24 Hour Urine Protein and Creatinine
    3. Blood sugar control
      1. Optimize blood sugar control prior to surgery
      2. Perioperative basal Insulin
        1. Lantus: Give full dose of Lantus even if NPO
        2. NPH: Give 60% of AM NPH and 100% of PM NPH
      3. Stop long-acting Insulin 1-2 days before surgery
        1. Replace with NPH and short-acting Insulin
      4. Stop Oral Hypoglycemic agents before surgery
        1. Hold long-acting Sulfonylureas 2-3 days before
        2. Hold short-acting Sulfonylureas night before
        3. Hold Metformin on day before surgery
        4. Thiazolidinediones may be continued
  3. Perioperative and Postoperative Glycemic Control
    1. Variable Rate Insulin Infusion (Insulin Drip)
      1. Preferred over use of Sliding Scale Insulin
  4. References
    1. Marks (2003) Am Fam Physician 67:93

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