Perioperative Diabetes Management

Quick Answer

Diabetes mellitus affects 5-10% of Australian surgical patients, with perioperative hyperglycaemia associated with increased wound infections (30% higher), mortality, and hospital length of stay. Preoperative optimization targets HbA1c <8% (64 mmol/mol) for elective surgery; urgent surgery proceeds with glucose management protocols. Insulin management follows "fasting guidelines": for morning surgery, omit short-acting insulin and give 50-80% of long-acting insulin; for afternoon surgery, give normal morning insulin, omit lunch short-acting, give 50-80% evening long-acting. Perioperative glucose target is 6-10 mmol/L (108-180 mg/dL) avoiding hypoglycaemia (<4 mmol/L) and severe hyperglycaemia (>15 mmol/L). Variable rate intravenous insulin infusion (VRIII) using 50 units actrapid in 50 mL 0.9% saline with concurrent 5% dextrose + KCl (10-20 mmol/L) infusion at 100-125 mL/hour, titrated using sliding scale based on hourly or 2-hourly glucose monitoring. Type 1 diabetes requires basal insulin continuation to prevent ketosis even when fasting (give 50-80% long-acting). Autonomic neuropathy increases risk of hypotension, gastroparesis, and silent myocardial ischaemia. Indigenous patients have 3-4 times higher diabetes prevalence with increased complications (nephropathy, neuropathy), requiring careful insulin dosing adjustments, renal function consideration, and culturally safe education on perioperative glucose management. [1-10]