Perioperative Management of Diabetes Mellitus Author: Nadia A. Khan, MD; William A. Ghali, MD; Susan E. Spratt, MD; Melanie E. Mabrey, MSN, ACNP, BC-ADM
Editorial changes - 2009-09-16
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Elements of Risk
Whom and How to Assess
Interventions to Decrease Risk
Patient Education
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Patient Education
  • Discuss with patients the planned glycemic management strategy and how to recognize hypoglycemia.
  • Use the perioperative setting to review strategies to prevent complications of diabetes.

Discuss with patients the planned glycemic management strategy and how to recognize hypoglycemia. C

  • Inform patients of the warning symptoms and signs of hypoglycemia and strategies to avoid and relieve them.
  • Instruct patients to regularly monitor their glucose levels when they alter their diets before surgery.
  • Instruct patients to continue their usual diabetic diets and to follow the surgeon's advice regarding when to stop eating.
  • Instruct patients that they will need to alter their outpatient drug therapy before surgery (see information on preoperative drug intervention).
  • Consider referring patients with poor control of their diabetes or those who are newly diagnosed with diabetes to patient education centers before or after the planned surgery.
  • Arrange for inpatient diabetes self-management education before discharge from the hospital for patients new to insulin therapy (initiated during the hospitalization).
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Use the perioperative setting to review strategies to prevent complications of diabetes. B

  • Use the perioperative setting to:
    • Review cardiac risk factors and appropriate risk reduction management, such as:
      • Smoking cessation
      • Lipid and BP control
      • Regular physical activity
    • Review diabetes glucose goals, including:
      • Fasting glucose goals
      • Postprandial glucose goals
      • HbA1C
      • How to recognize and treat hypoglycemia
    • Review diabetic complications and appropriate management, such as screening according to accepted recommendations for:
      • Diabetic nephropathy
      • Peripheral neuropathy
      • Foot care
      • Infections
      • Retinopathy
  • See module Diabetes Mellitus, Type 1.
  • See module Diabetes Mellitus, Type 2.
  • See module Chronic Stable Angina.
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FAQs
Melanie E. Mabrey, MSN, ACNP, BC-ADM has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Nadia A. Khan, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Susan E. Spratt, MD, Consultant and speaker for Sanofi Aventis and Novo Nordisk. William A. Ghali, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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