Pre-operative Assessment:

Patients with diabetes should undergo a comprehensive pre-operative assessment to determine their current glycemic control, evaluate for any diabetes-related complications, and assess their overall health status. The assessment should also include a review of their medications, including insulin, and any other comorbidities that may affect their peri-operative management.

Glycemic Control:

The goal of glycemic control in patients with diabetes is to maintain blood glucose levels within a safe range during the peri-operative period. Tight glycemic control can reduce the risk of peri-operative complications, such as wound infections and delayed healing. Pre-operative blood glucose levels should be monitored, and the use of insulin or other glucose-lowering agents should be adjusted accordingly.

Fasting:

Patients with diabetes should be advised on the proper management of their diabetes medications and insulin regimens during the peri-operative period. Patients may require adjustment of their insulin dose or medication schedule to account for fasting requirements before surgery.

Intra-operative Management:

Intra-operative glucose levels should be monitored closely, and adjustments to insulin or glucose-lowering agents should be made as necessary. Maintaining normoglycemia during surgery is important, as hyperglycemia can increase the risk of infection and delayed healing.

Post-operative Care:

Restart all oral medication the morning after surgery

After surgery, patients with diabetes should continue to have their blood glucose levels monitored and their diabetes medications adjusted as necessary. Patients may require more frequent glucose monitoring during the recovery period to ensure adequate glycemic control.