Perioperative management of diabetes mellitus

Day of Operation

Check hstix and blood

sugar
*postpone if >11mmol/L

Major Surgery Minor surgery

Sever DM on high dose

Mild DM Mild DM on OHA Well controlled on insulin Poor controlled on insulin
OHA or Insulin

DKI at least 2 hrs pre-op

D5 500ml Q4H alone
*monitor hstix, K and give fluis Continue OHA/diet Omit the short acting dose DKI infusion for urgent OT
*monitor K and hstix
as dextrose free solutions

Give 2/3 of intermdeiate Safer:

acting insulin am and the DKI until diet resumed
remaining 1/3 when Then 1/3 to 1/2 of usual
patient can eat inetermediate acting insulin