Preoperative Management
Blood Glucose Control
- Target blood glucose 80-180 mg/dL perioperatively to reduce infection risk and promote wound healing
- NPO status requires sliding scale insulin or continuous insulin infusion to prevent hyperglycemia
- Hold metformin 24-48 hours before surgery due to lactic acidosis risk with contrast agents
- Morning surgery preferred to minimize fasting time and metabolic disruption
Memory Aid: "FAST" - Frequent monitoring, Avoid long fasting, Sliding scale ready, Target 80-180
Key Points
- Check HbA1c - surgery may be delayed if >8.5%
- Assess for diabetic complications (neuropathy, nephropathy, retinopathy)
- Monitor for signs of infection - delayed healing common
Intraoperative Management
Glucose Monitoring & Insulin Administration
- Check blood glucose every 1-2 hours during lengthy procedures
- Use insulin drip protocol for major surgeries - allows precise titration
- Maintain glucose 140-180 mg/dL intraoperatively - prevents hypoglycemia under anesthesia
- Administer dextrose-containing IV fluids if glucose drops below 100 mg/dL
Clinical Scenario: A diabetic client's glucose drops to 85 mg/dL during surgery. The nurse should immediately notify the anesthesiologist and prepare to administer D5W or D10W per protocol while continuing glucose monitoring.
Commonly Confused Points
Hypoglycemia vs Hyperglycemia Recognition
| Hypoglycemia | Hyperglycemia |
|---|
| Diaphoresis, tremors, confusion | Polyuria, polydipsia, fruity breath |
| Rapid onset | Gradual onset |
| Give glucose immediately | Increase insulin, check ketones |
| More dangerous acutely | Dangerous if prolonged |
Memory Aid: "TIRED" for hyperglycemia - Thirsty, Increased urination, Rapid breathing, Elevated glucose, Drowsy