These principles take into account the Blct that surgery and anaesthesia are stress situations which require extra insulin, and may lead to hypo-glycemi:~ or kcto-acidosis.
The management depends on tlie combination of following factors:
1) Type of surgery: Major or minor:
All patients undergoing ~nqjor surgely need to be on insulin i~~espective of prior inode of therapy.
2) Elective or emergency: Emergency surgeiy requires intensive monitoring and control during the procedure, and patient usually needs to be on insulin.
3) Well controlled/ poorly controlled diabctes: Well controlled diabetics need to usually remain on their previous tllerapy prior to surgery, but may need to bc given extra insulin for 24 to 48 hours post-operatively.
4) Patient on insulildpatient on OHA prior to surgery: Patients on OHA may omit tablet on the day of surgery, if it is minor, and resume when the procedure is over and order to eat is given. Those on insulin should be given insulin along with 5 per cent glucose piior to surgery, should be monitored during and after surgery,and soluble insulin given as needed.
Examples
1) A well controlled patient on 01-IA undergoing he~niorraphy under a short general anesthesia. This patient can be advised to be fasting, ornit OHA on day of surgery, restart OHA before evening meal if post operative sugars below 250mgs.
2) A poorly controlled diabetic on OHA needs to undergo bowel resection. This is a major surgery. The surgery should be delayed for 48 to 72 hours while insulin is started and dose is optimized; bowel preparation can be done sin~ultaneously. On the day of surgeiy, insulin /glucose /potassium drip is started and patient is fasting. Insulin is continued post-operatively till the patient is allowed to eat orally.
The management depends on tlie combination of following factors:
1) Type of surgery: Major or minor:
All patients undergoing ~nqjor surgely need to be on insulin i~~espective of prior inode of therapy.
2) Elective or emergency: Emergency surgeiy requires intensive monitoring and control during the procedure, and patient usually needs to be on insulin.
3) Well controlled/ poorly controlled diabctes: Well controlled diabetics need to usually remain on their previous tllerapy prior to surgery, but may need to bc given extra insulin for 24 to 48 hours post-operatively.
4) Patient on insulildpatient on OHA prior to surgery: Patients on OHA may omit tablet on the day of surgery, if it is minor, and resume when the procedure is over and order to eat is given. Those on insulin should be given insulin along with 5 per cent glucose piior to surgery, should be monitored during and after surgery,and soluble insulin given as needed.
Examples
1) A well controlled patient on 01-IA undergoing he~niorraphy under a short general anesthesia. This patient can be advised to be fasting, ornit OHA on day of surgery, restart OHA before evening meal if post operative sugars below 250mgs.
2) A poorly controlled diabetic on OHA needs to undergo bowel resection. This is a major surgery. The surgery should be delayed for 48 to 72 hours while insulin is started and dose is optimized; bowel preparation can be done sin~ultaneously. On the day of surgeiy, insulin /glucose /potassium drip is started and patient is fasting. Insulin is continued post-operatively till the patient is allowed to eat orally.
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