Guidelines for Perioperative Management of the Diabetic Patient

Table 1

Broad management goals across the perioperative timeline. Overall goals: (i) reduce patient morbidity and mortality, (ii) avoid clinically significant hyper- or hypoglycemia, (iii) maintain acid/base, electrolyte, and fluid balance, (iv) prevent ketoacidosis, and (v) establish blood glucose measurements less than 180 mg/dL in critical patients and less than 140 mg/dL in stable patients.

Preoperative management key points	Intraoperative management key points	Postoperative management key points
(i) Verify target blood glucose concentration with frequent glucose monitoring; (ii) Use insulin therapy to maintain glycemic goals; (iii) Discontinue biguanides, alpha glucosidase inhibitors, thiazolidinediones, sulfonylureas, and GLP-1 agonists; (iv) Consider cancelling nonemergency procedures if patient presents with metabolic abnormalities (DKA, HHS, etc.) or glucose reading above 400–500 mg/dL	(i) Aim to maintain intraoperative glucose levels between 140 and 170 mg/dL; (ii) Physicians must take length of surgery into account when determining an intraoperative glucose management strategy; (iii) For minor surgery, preoperative glucose protocols may be continued; (iv) IV insulin infusion is being promoted as a more efficient method of glycemic control for longer or more complex surgeries	(i) Target postoperative glycemic range between 140 and 180 mg/dL; (ii) In the event a patient is hypoglycemic after surgery, begin a dextrose infusion at approximately 5–10 g/hour; (iii) Ensure basal insulin levels are met, especially in type 1 diabetic patients; (iv) Postprandial insulin requirements should be tailored according to the mode in which the patient is receiving nutrition; (v) Supplemental insulin can be used to combat hyperglycemia and restore blood glucose values back to target range

Please note that the information presented in this table has been referenced in the text.