PRE AND PERI OPERATIVE PERIOD: MEDICATION MANAGEMENT
The following instructions are for diabetic patients undergoing day surgery
procedures who are expected to miss one meal.
Diabetic patient undergoing major surgery should be placed on a variable rate
insulin infusion (please see chart and guidelines).
Diabetics on Insulin medication
MORNING SURGERY
Once daily dose (morning/evening) – medication taken as normal
Twice daily dose – Omit morning dose, insulin resumed with next meal
3/4/5 injections daily – Continue long-acting insulin. Stop short-acting insulin morning
of operation and resume with next normal meal.
AFTERNOON SURGERY
Once daily dose (morning/evening) – medication taken as normal
Twice daily dose – Omit morning dose, insulin resumed with next meal
3/4/5 injections daily – Continue long-acting insulin. Take morning short-acting
insulin and resume with next meal after surgery.
Diabetics on Non-insulin medication (OHAs)
MORNING SURGERY
OMIT morning dose and continue as usual in pm if eating (twice daily dose) –
Sulphonlyureas
OMIT on day of surgery – all other medications including exenatide, sitagliptin,
metformin
AFTERNOON SURGERY
OMIT all diabetic medication on day of operation
PERI OPERATIVE PERIOD: HYPERGLYCAEMIA
The management of hyperglycaemia in a diabetic patient undergoing surgery with
short starvation time (one missed meal)
Aim blood glucose level between 4-12mmol/l
Patients who have blood glucose level >13mmol/l can receive two doses of subcutaneous
insulin (Novorapid) 2 hours apart in the perioperative period in an effort to correct their
hyperglycaemia. If after this time the patient’s blood glucose level is not between 4-12mmol/l
they should be started on Scale A on the Intravenous Insulin chart.
The dose of subcutaneous insulin the patient will receive will depend on their blood
glucose level and type of diabetes. PLEASE SEE SUBCUTANEOUS INSULIN CHART
FOR ELECTIVE SUGERY (ADULT).
Type 1 Diabetes
1. Blood glucose >13mmol/L
2. Check for ketones in the urine – if positive (+++) cancel surgery, follow DKA guidelines
and contact diabetes specialist teams.
3. If no ketones, give subcutaneous rapid acting insulin (Novorapid) according to the blood
glucose.
4. Recheck blood glucose after 1 hour
5. Take advice from the patient on amount of insulin that corrects their high blood glucose
Glucose
13-15
16-18
19-21
22-24
25-27
28-30
Insulin units
1
2
3
4
5
6
Type 2 Diabetes (Tablet and Insulin controlled)
1. Blood glucose >13mmol/L
2. Give subcutaneous rapid acting insulin
(Novorapid) according to the blood glucose.
3. Recheck blood glucose after 1 hour
4. If remains >13mmol/L the next dose should take into account the response to the initial
dose – consider doubling if response inadequate.
Refer to diabetes specialist team if still not controlled
Weight
(kg)
50-59
60-69
70-79
80-89
90-99
100+
Insulin units
5
6
7
8
9
10