Return to flip book view

FASTING FOR SURGERY ELECTIVE PROCEDURES INSTRUCTIONS FOR PATIENTS WITH DIABETES TYPE 1 AND TYPE 2

FASTING FOR SURGERY ELECTIVE PROCEDURES INSTRUCTIONS FOR PATIENTS WITH DIABETES TYPE 1 AND TYPE 2 General Instructions Patients preparing for elective surgery and elective procedures should aim to have their diabetes well controlled prior to coming into hospital This helps to minimise your risk of infection and other complications after your procedure Ideally you should aim to have your HBAIC less than 69mmol mol before coming in to hospital Please ask your GP if you are unsure If you are having frequent hypos less than 4mmol L or frequent high blood glucose levels more than 10mmol L you should consider going to see your GP or diabetes team to help you to improve your blood glucose levels before coming into hospital If you do not normally check your blood glucose levels at home please contact your GP who will advise if you need to use a glucometer at home Instructions for When You Start to Fast Nothing to Eat or Drink 1 Check your blood glucose level BGL every hour from when you wake up or from 8am Target BGL is 6 10mmol L 2 If your BGL is outside the target range then commence hourly BGL readings 3 If the glucose level is less than 4 0 mmol L see instructions below for HYPOGLYCAEMIA TREATMENT If you have had any blood glucose level below 4mmol L please inform the nurse in the day unit when you arrive If you feel shaky faint hot or sweaty you should also check your blood glucose These feelings can be a sign of low blood glucose You should check your blood glucose level and if your blood glucose level is less than 4mmol L you should treat as a hypoglycaemia

HYPOGLYCAEMIA TREATMENT If your blood glucose level is 4 0 mmol L or less 1 Drink a glass 150mls of non diet mineral sugary drink or 150mls fruit juice three to four glucose sweets or a Lift Glucojuice drink 2 Re check your blood glucose level 15 minutes later and if it is still less than 4 0 mmol L repeat step 1 3 Re check your blood glucose level 15 minutes later and if it is still ess than 4 0 mmol L repeat step 1 4 This can be repeated every 15 minutes if the blood glucose remains less than 4 0 mmol L 5 Continue to check your blood glucose every 15 minutes until it has been above 4 0 mmol L for 45 minutes 6 Then resume checking every hour until blood glucose level is above 6mmol L 7 When your blood glucose level is between 6 10 mmol L you can continue to check your blood glucose level every 2 hours 8 If you have a hypoglycaemic episode before you come into hospital for your procedure please tell the nurse on duty when you are admitted Diabetes Medications Check which types of diabetes medications you are on and then follow the instructions in the next section Any tablets for diabetes Diabetes Tablets Lantus Levemir Tresiba Toujeo Long acting insulin Novorapid Humalog Apidra Fiasp Short acting insulin Novomix 30 Humalog Mix 25 Humalog Mix 50 Mixed insulin Byetta Bydureon Victoza Trulicity Ozempic GLP 1 injections Continuous subcutaneous insulin infusion pump Insulin Pump Novorapid Humalog Fiasp Insulin

3 days prior to starting to fast you should STOP taking SGLT 2 medications and you should not resume these medications until you are back to eating a full normal diet after your procedure with no nausea Usually these are not resumed until the next day SGLT 2 medications are Empagliflozin Dapagliflozin Jardiance Forxiga Canagliflozin Invokana Ertugliflozin Steglatro If you are not sure of your medications or if you are on a tablet that contains one of these medications please contact your GP at least week before the procedure for advice On arrival to the hospital please advise the nurse if you have had any of the following 1 Any hypoglycaemia episodes requiring treatment while fasting or any frequent hypoglycaemia in the week leading up to surgery 2 If you have any high blood glucose while fasting and if you have taken a correctional dose of insulin prior to coming in 3 If you have had any ketones while fasting prior to coming into hospital and if you have needed to follow sick day rules to clear ketones or correct high blood glucose levels 4 If you are wearing an insulin pump please advise the anaesthetist surgeon and nurse who admits you to the unit 1 Instructions for Patients with Diet Controlled Type 2 Diabetes If you have type 2 diabetes that is controlled with diet only then you will fast as directed by your surgeon prior to your procedure If you have not had a check up recently for your diabetes you should consider seeing your GP prior to surgery to ensure that your diabetes is adequately managed by diet alone 2 Instructions for Patients with Diabetes Type 1 and Type 2 Who Are Treated with Oral Diabetes Medications or Injectable Medication That Is Not Insulin Day of Surgery Tablets Day Prior to Admission Meglitinide repaglinide or nateglinide Take as normal Hold Hold Metformin Glucophage If you are due contrast media on the day of the procedure you should not restart metformin for a further 48 hours your doctor should tell you in advance Take as normal Hold Hold Patient for Patient for AM surgery PM surgery

Day of Surgery Tablets Day Prior to Admission Sulphonylureas glibenclamide glipizide gliclizide gliclizide MR glimepiride Take as normal Hold Hold Thiazolidinediones Pioglitazone Take as normal Hold Hold DPP4 inhibitors sitagliptin saxagliptin vildagliptin linagliptin Take as normal Hold Hold GLP 1 analogue exenatide liraglutide dulaglutide semaglutide Take as normal Hold Hold SGLT 2 inhibitors canagliflozin dapaglifozin empagliflozin Ideally hold for 72 hours 3 days prior to surgery Patient for Patient for AM surgery PM surgery Hold Hold Do not restart until you are eating drinking normally with no nausea If you have had a morning procedure you can restart your oral medications not SGLT 2 and GLP 1 injections when you start to eat and drink normally following your procedure If you have had an afternoon surgery resume all oral medication and GLP 1 medications on the morning after surgery when you are eating and drinking normally Patients admitted to the hospital following their procedure will be managed according to hospital policy SGLT 2 inhibitors should be held until at least the next day when you are tolerating a full diet with no nausea or vomiting

3 Instructions for Patients with Diabetes Type 1 and Type 2 Who Are Treated with Insulin Day of Surgery Insulin Day Prior to Admission Once daily Evening No dose adjustment Necessary No dose adjustment Necessary No dose adjustment Necessary No dose adjustment Necessary No dose adjustment Reduce your usual dose by 20 Lantus Levemir Tresiba Toujeo Once daily Morning Lantus Levemir Tresiba Toujeo Patient for AM surgery or Patient for PM surgery Reduce usual dose by 20 if history of frequent hypoglycaemia or morning BGL usually less than 6 mmol L Twice Daily Novomix 30 Humalog Mix 25 Humalog Mix 50 Twice daily levemir or lantus Short Acting Meal time Insulin No dose adjustment Necessary No dose adjustment Necessary Take HALF of your usual dose in the morning Take HALF of your usual dose in the morning Resume your normal insulin with your evening meal Resume your normal insulin with your evening meal Omit your morning dose of short acting insulin if no breakfast is eaten Take your usual morning insulin dose with breakfast Omit your lunch time dose if no lunch is eaten Omit lunchtime dose if no lunch is eaten Resume your usual insulin dose with your evening meal Resume your usual insulin dose with your evening meal Resume usual insulin doses the morning after surgery if you are eating and drinking normally Patients with Type 1 diabetes who are fasting for surgery or an elective procedure and have a Blood glucose level more than 12mmol L should check their blood for ketones and follow their usual sick day rules If your

Blood glucose level or ketone level continues to rise despite corrective insulin please contact your usual diabetes team or out of hours the Emergency Department 4 Instructions For Patients with Diabetes Type 1 and Type 2 Who Are Treated with Continuous Subcutaneous Insulin Infusion Insulin Pump Insulin pump Do not change basal rates If your blood glucose becomes HIGHER than 15mmol L you should enter your blood glucose level into the bolus calculator and give the suggested correction dose Advice For Patients Using an Insulin Pump 1 Please ensure that you have done a set and cannula change the day before your procedure and that you have sited the cannula away from the proposed surgical site 2 Please bring your insulin pump sundry items with you to hospital 3 If you are using a continuous sensor with your insulin pump this also needs to be sited away from the proposed surgical site The nurses will use the hospital glucometer also to record your blood glucose levels while you are in hospital 4 If for any reason your pump is disconnected during surgery you will advised following the procedure and your pump will be returned to you as soon as you are awake and conscious Your diabetes will be managed during the procedure by the anaesthetist managing your case All patients with diabetes type 1 and type 2 MUST arrange for an adult to drive you to the hospital and to collect you after your procedure to drive you home You will not be allowed to leave the hospital unaccompanied following an anaesthetic References Association of Anesthetists of Great Britain and Ireland AAGB Consensus Document 2015 Perioperative management of the surgical patient with diabetes Anesthesia 70 Pages 1427 1440 Inpatient blood glucose levels management in adult diabetes patients 2018 Ballarat Diabetes Accessed online at http ballaratdiabetes com guidelines inpatientbloodglucoselevelsmanagement Accessed 27 7 18 Joint British Diabetes Societies for Inpatient care 2021 Management of adults with diabetes undergoing surgery and elective procedures Improving standards Updated March 2021 Kerridge R Whyte I Prior F Luu J and Story D A 2018 The good the bad and the ugly sodium glucose cotransporter 2 inhibitors gliflozins and perioperative diabetes Anaesth Intensive Care Mar 46 2 pages 155 158 Umpierrez G E 2018 Inpatient management of diabetes Goals challenges and implications Endo 2018 Meet the professor Clinical Case Management Presented March 17 20 2018

Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 6600 www beaconhospital ie