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It is always important to manage your blood glucose, but it is especially important to have good glucose control before surgery. Managing your blood glucose effectively before surgery helps reduce your risk of infection and other potential problems after surgery.
Stress before, during, and after surgery can cause your body to release hormones and other inflammatory substances that can cause your blood glucose levels to change. Other changes related to surgery, such as alterations in diet and medication routine can also make it harder to manage your blood glucose levels
Before you schedule the surgery, make an appointment with the doctor who manages your diabetes for a comprehensive checkup. Review your self-management guidelines and ask your doctor about the best way to manage diabetes before surgery. Your doctor may request additional tests during this visit in preparation for the surgery.
Ask your doctor how you should adjust your diabetes medications or insulin before surgery.
Inform the person who schedules your surgery that you have diabetes and would like your surgery to be scheduled early in the morning (ideally before 9 AM). This causes the least amount of change to your insulin or diabetes medication schedule.
If you use an insulin pump and will have general anesthesia or a surgery that lasts longer than one hour, your insulin pump will likely need to be disconnected before surgery. Your doctors will switch you to an alternative form of insulin therapy and the pump needs to be stored in a safe location during this period. You will be reconnected when you are able to safely manage it on discharge.
The week before surgery
Carefully follow your diabetes treatment plan and test your blood glucose as directed by your doctor. Record the results and bring your blood glucose record with you when you come for surgery.
Your pre-meal blood glucose goal should be 80 to 130 mg/dl (4.4-7.2 mmol/L)* or _______________________________
Your bedtime blood glucose goal should be 100 to 140 mg/dl (5.6-7.8 mmol/L)* or ______________________________
*More or less stringent targets may be appropriate for select patients as advised by the doctor
For patients with type 2 diabetes managed with diet alone, no changes are usually needed. Supplemental short-acting insulin may be given (typically every 4 - 6 hours) if glucose levels rise over the desired targets during or after surgery.
For patients with type 2 diabetes who take oral hypoglycemic drugs or noninsulin injectables (e.g. glucagon-like peptide-1 [GLP-1] analogs [like exenatide or liraglutide]), their anti-diabetic medications are usually stopped the morning of surgery. Supplemental short-acting insulin may be given (typically every 4 - 6 hours) if glucose levels rise over the desired targets during or after surgery. When you are able to eat again, your doctor may resume your prior home regimen or switch you to an alternative schedule of medications.
For patients with type 1 or type 2 diabetes who are treated with insulin, subcutaneous insulin can be continued before the operation at a reduced dose for procedures that are not long and complex (eg, no more than one or two missed meals). However, intravenous (IV) insulin may be required for long and complex procedures (like open heart surgery or kidney transplantation). When you are able to eat again, your doctor may resume your prior home regimen or switch you to an alternative schedule of medications.
If your blood glucose level is too high on the morning of surgery, ask a family member or a friend to bring you to the hospital.
Supplemental short-acting insulin may be given to bring your blood glucose level to target.
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This information is provided by Cleveland Clinic Abu Dhabi, part of Mubadala Healthcare, and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.
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