Preoperative diabetic considerations
Jul 07, 2025
Sugar rush - Preoperative diabetic considerations 💉
Diabetes management is a critical aspect of perioperative care with direct impacts on surgical outcomes and patient recovery. Poor management can lead to delayed wound healing and wound infections, cardiovascular events, and in extreme cases, perioperative mortality.
The 2015 guideline from the association of Anaesthetists of Great Britain and Ireland details comprehensive recommendations for the perioperative management of surgical patients with diabetes. It is important for perioperative nurses to understand and implement these guidelines in order to optimise patient care and improve surgical outcomes. Here's a snapshot look at the key elements of the guideline:
Preoperative assessment:
🔹 Glycaemic control should be assessed preoperatively, aiming for HbA1c <69mmol/mol.
🔹 This assessment should be completed well in advance of surgery to allow time for optimisation.
Medication management: 💊
🔹 Adjustments to diabetic medications are essential prior to surgery.
🔹 Depending on the medication type, they may be stopped several days beforehand, on the day of surgery, or continued with modified dosing - as is the case for many types of insulin.
🔹 These plans need to be clearly documented and communicated to perioperative staff to avoid miscommunications and errors.
Fasting: ⏳
🔹 Diabetic patients are at a higher risk of hypo/hyper glycaemia during fasting periods.
🔹 Regular blood glucose monitoring is imperative to ensure patient safety, and these patients should be prioritised to the beginning of the list where possible.
Intra and Postoperative Considerations:
🔹 Regular blood glucose monitoring should continue intra and post operatively, and should be maintained within a specific target range.
🔹 Post operatively, early resumption of diet and regular diabetic medication should be encouraged, with a clearly documented plan for ongoing nursing care.
Communication and Education: 🩺
🔹 As always, communication and education are the powerhouses of gold standard patient care, with collaboration between surgical, anaesthetic and nursing staff, as well as the patient, critical in optimising surgical outcomes.
As key members of the multidisciplinary team, perioperative nurses are uniquely placed to identify risks and errors, ensure appropriate fasting protocols are in action, and advocate for regular and timely blood glucose monitoring. This role is vital in safeguarding our patients and supporting optimal patient care.
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References:
Membership of the Working Party, Barker, P., Creasey, P. E., Dhatariya, K., Levy, N., Lipp, A., Nathanson, M. H., Penfold, N., Watson, B., & Woodcock, T. (2015). Peri-operative management of the surgical patient with diabetes 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 70(12), 1427–144
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