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Perioperative Hyperglycemia Management

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Dr Shalini Jaggi, New Delhi    31 January 2018

  1. mortality. Poor perioperative glycemic control: ↑ risk of adverse outcomes. There is a strong correlation between perioperative hyperglycemia and increased complications, especially nosocomial infection. Pre-existing metabolic disturbances are exacerbated by surgery. Metabolic impact of surgery may worsen glycemic control. Metabolic worsening can result in increased mortality, morbidity and length of hospital stay.
  2. Management strategy: Baseline assessment: History and examination, type of diabetes, glycemic status, current medications, associated complications (ECG, renal and cardiac functions); Goals: Maintaining euglycemia with avoidance of hypoglycemia, prevention of ketoacidosis, maintenance of fluid and electrolyte balance; Target: aim to keep the glucose readings between 140 and 180 mg/dL; Ideally, all patients with diabetes mellitus should have their surgery prior to 9 AM to minimize the disruption of their management routine while being NPO; IV insulin infusion is usually required for long and complex procedures (e.g., CABG, renal transplant or prolonged neurosurgical operations) or any patient with poor glycemic control. Patients with type 2 diabetes on OADs or noninsulin injectables - hold these agents on the morning of surgery: Correction insulin (usually 6 hourly) until the patient is eating and either can resume oral agents/noninsulin injectables or a basal-bolus insulin regimen is initiated.
  3. Patients who are on insulin can continue with SC insulin perioperatively at a reduced dose (rather than an insulin infusion) for procedures that are not long and complex (e.g., no more than one or two missed meals).

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