Page 82 - Demo

Perioperative Management of DiabetesPatients on insulin (elective major surgery):%u2022 Day before surgery: 80% of total daily long-acting insulin + other insulin as usual%u2022 Intraoperative: 80% of total daily long-acting insulin, stop other insulin%u2022 Start IV infusion of KCl + glucose + NaCl to avoid hypoglycemia%u2022Continue until oral intake resumesGlucose management:%u2022 Target range: 6-10 mmol/L (up to 12 mmol/L acceptable)%u2022Constant rate glucose-containing fluid infusion + variable rate insulin infusionPatients on oral hypoglycemics:%u2022 Surgery requiring missing one meal: Continue same medications%u2022 Longer surgeries or uncontrolled DM: Switch to insulin and monitor glucose levelsEmergency surgery (all patients):%u2022Check blood glucose, ketones, serum electrolytes, and bicarbonate%u2022 Rule out ketoacidosis