Diabetes mellitus type 1 and surgery
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- The major aims are to prevent both hypoglycaemia and significant hyperglycaemia before/during and after surgery.
- Surgery should generally not need to be cancelled on the basis of the diabetic state without consultation with the Diabetic Team.
Issues to Consider
- Time of surgery
- Length of surgery
- Urgency of surgery
If unclear discuss with Endocrine consultant / fellow on call via switchboard.
- Aim for morning surgery and for the child to be first on the list.
- Notify the Diabetes team the day before surgery (Paediatric Endocrine Registrar or Consultant / Fellow on call) if unable to contact the registrar.
- Aim for blood glucose: 5 - 10mmol/l
If surgery is in the morning
The night before and at home
Child is given normal food and insulin requirements until midnight prior to surgery. Often they are nervous so reducing evening insulin by 10% is fine.
2-3 hours before surgery (normally 6 a.m.) a blood glucose should be performed. If less than 5mmol/l, the child should be given a drink of lemonade or other palatable sugar containing clear fluid (10% sugar). The amount given should be between 5 and 10ml/kg body weight with a maximum of 200ml. A note should be made on the chart informing the Anaesthetist that this action has been taken. Also let the nurses/day stay know.
Day Stay / Ward
It is not desirable to insert an intravenous infusion in the ward as this can be done when the child arrives in theatre. If however, blood glucose values are less than 4mmol/l within two hours of surgery, intravenous glucose (5% glucose at maintenance initially) should be commenced to prevent a further fall, or a minidose of glucagon (1 unit/kg of subcutaneous Glucagon) - discuss with Endocrinology.
There should be regular blood glucose estimations including one just before leaving the ward.
Measure blood glucose 2 hourly and aim to keep glucose between 5 - 12mmol/l.
When tolerating oral fluids, the IV infusion can cease but blood glucose monitoring should continue 4 hourly and insulin be given once eating.
Acute Minor Surgery
All cases to be discussed with the Paed Endocrine Consultant on Call via switchboard
For very minor surgery and a short anaesthetic
IV glucose may not be necessary providing oral intake can be resumed soon after surgery and providing the pre-operative blood glucose concentration is not less than 6mmol/l.
If in doubt about patient's likely post-operative state, then it is safer to follow the regime for elective surgery outlined above.
For example, often for a gastroscopy, two thirds normal protaphane subcutaneous in the morning; then novorapid at lunch if eating again, then home.
Acute Major Surgery
All cases to be discussed with the Paed Endocrine Consultant on Call via switchboard.
For emergency and major surgery.
For preparation for emergency surgery, the child should first be assessed clinically and biochemically. If ketoacidosis or dehydration is present, treatment according to the diabetic ketoacidosis protocol should be commenced immediately and the patient stabilised before surgery. The diabetes consultant should be contacted.
The child should have intravenous dextrose/saline infusion and continuous insulin IV infusion before, during and after surgery. The initial rate will be ~0.1U/kg/hour according to hourly blood glucose concentrations. This should continue until oral feeding is resumed.
Information for Families
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- Date last published: 26 January 2017
- Document type: Clinical Guideline
- Services responsible: Paediatric Endocrinology
- Author(s): Craig Jefferies
- Editor: Greg Williams
- Review frequency: 2 years
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