What are the current guidelines for managing hyperglycemia in diabetic patients before, during, and after surgery?

Indunil Karunarathna @Indunil-Karunarathna

08 May 2024 1 7K Report

What are the current guidelines for managing hyperglycemia in diabetic patients before, during, and after surgery?Article The Impact of Hyperglycemia on Perioperative Outcomes in Pat...

Indunil Karunarathna

Article The Impact of Hyperglycemia on Perioperative Outcomes in Pat...

The management of hyperglycemia in diabetic patients before, during, and after surgery involves a multifaceted approach guided by evidence-based recommendations from professional medical organizations. While specific guidelines may vary slightly depending on the organization, here are the general principles and current guidelines for managing hyperglycemia in diabetic patients throughout the perioperative period:

Preoperative Management:Assess and optimize glycemic control before surgery, aiming for target blood glucose levels typically between 80-180 mg/dL (4.4-10 mmol/L). Review the patient's diabetes management regimen, including medications (oral hypoglycemic agents and insulin), dietary habits, and exercise routine. Consider discontinuing non-essential medications that may affect glucose metabolism, such as corticosteroids, if possible. Address any comorbidities that may impact perioperative glucose management, such as cardiovascular disease or renal impairment. Provide education to patients regarding preoperative fasting instructions, medication adjustments, and glucose monitoring protocols.

Intraoperative Management:Monitor blood glucose levels closely during surgery using continuous glucose monitoring (CGM) or frequent point-of-care glucose testing. Adjust insulin infusion rates or administer supplemental glucose as needed to maintain euglycemia (target range: 80-180 mg/dL or 4.4-10 mmol/L) throughout the procedure. Consider the patient's insulin sensitivity, anticipated stress response, and duration of fasting when determining insulin dosing strategies. Communicate with the surgical team, anesthesiologist, and nursing staff to coordinate perioperative glucose management and address any intraoperative glucose fluctuations promptly.

Postoperative Management:Continuously monitor blood glucose levels in the postoperative period and initiate insulin therapy as needed to maintain euglycemia. Resume the patient's regular diabetes medications once oral intake is resumed and the patient's clinical condition permits. Provide adequate nutritional support to meet the patient's energy and glucose requirements, considering early enteral or parenteral nutrition if oral intake is compromised. Educate patients and caregivers about postoperative glucose monitoring, medication administration, and signs of hyperglycemia or hypoglycemia. Monitor for and promptly address any postoperative complications related to hyperglycemia, such as wound infections, cardiovascular events, or respiratory complications.

Long-term Follow-up:Ensure continuity of care by coordinating with the patient's primary care provider or endocrinologist for long-term diabetes management. Schedule regular follow-up visits to monitor glycemic control, assess for any perioperative complications, and adjust diabetes management regimens as needed.

These recommendations are based on guidelines from organizations such as the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), and the Society of Hospital Medicine (SHM). It's essential to individualize perioperative glycemic management plans based on each patient's specific medical history, surgical factors, and metabolic needs. Close interdisciplinary collaboration among healthcare providers is key to optimizing perioperative glucose control and improving outcomes for diabetic patients undergoing surgery.

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