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Goals:
- Avoid hypoglycemia
- Avoid marked hyperglycemia
- Prevent DKA and HHS
Consider checking Hemoglobin A1c if not done recently
Consider delaying elective surgery to improve glycemic control (weighing risks/benefits)
For patients on a well-balanced regimen (e.g. lantus 30U with lispro 10U with meals), consider 20% to 30% reduction of basal dose.
For patients on an excessive basal insulin (e.g. lantus 50U with lispro 4U with meals), consider a larger dose reduction of 30-50%.
Clearly document if a patient has Type 1 Diabetes. These patients MUST receive basal insulin.
For long surgeries (>3 hours) or very poorly controlled diabetes, the anesthesiologist may use an insulin drip in the OR.
Hold oral hypoglycemic agents, rapid/premix insulin, and non-insulin injectables on the day of surgery.
- Hold sodium-glucose co-transporter 2 (SGLT2) inhibitors (empagliflozin, dapagliflozin, canagliflozin) for 3-4 days prior to surgery.
Associated with an increased risk of UTI and hypovolemia. Reports of AKI and euglycemic diabetic ketoacidosis.
Tips adapted from “Peri-operative Management of Diabetes” lecture given by Dr. Erin Gabriel (2022).