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Diabetes mellitus type 1 and surgery

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  • The major aims are to prevent hypoglycaemia during, and significant hyperglycaemia before/after surgery.
  • Surgery should not 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

Elective Surgery

Discuss with Endocrine consultant / fellow on call (cell phone # 021 974 804)

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 935088) or Consultant / Fellow on call if unable to contact the registrar.

Aim for blood glucose: 5 - 10mmol/l

For Example:

If surgery is in the morning:

Child is given normal food and insulin requirements until midnight prior to surgery.

2 1/2 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.

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% Dextrose at maintenance initially) should be commenced to prevent a further fall.

There should be regular blood glucose estimations including one just before leaving the ward.

After surgery:

Measure blood glucose 2 hourly and aim to keep glucose between 5 - 10mmol/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 -021 974 804

For very minor surgery and a short anaesthetic

IV dextrose 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.

Acute Major Surgery

All cases to be discussed with the Paed Endocrine Consultant on Call -021 974 804

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

There are a number of factsheets about diabetes on Kidshealth (

Did you find this information helpful?

Document Control

  • Date last published: 01 August 2008
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Endocrinology
  • Author(s): Craig Jefferies
  • Editor: Greg Williams
  • Review frequency: 2 years

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