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Unwell Pre Admission care

Planning for an elective admission in the clinic

Morbidity and outcome success for elective admissions for minor or major surgical intervention or for invasive investigations rely strongly on good glycaemic care during the pre-, peri- and post-operative periods.

Patients not known to hospital diabetes teams will rely on their usual diabetes care-giver to prepare them for such procedures, although many routine day case procedures will have standard operating procedure guidelines for diabetic patients that will be administered through the investigating team. There are however a number of actions that can ensure a smooth admission experience for your patient in the run up to such admissions

  1. Ensure an HbA1c result is available within 3 months of the planned admission date (usual control may determine if day-case procedures are safe/practical
  2. Ensure the patient has a monitoring plan that will detect risk periods for hypoglycaemia (esp overnight) if a starve is required

Generally insulin requirements around a short procedure where IV insulin is not required will follow a predictable pattern:

A     
Usual requirement until evening before procedure (unless bowel prep is required)
B
Overnight before the procedure (if starved) usual basal insulin requirement (-20% if usual control HbA1c less than 8%; -50% if usual control less than 6% or if has past history of overnight hypoglycaemia)

C

Peri-operative period – basal insulin requirement (but NO short-acting insulin, so if on a pre-mixed preparation give 50% usual dose using basal (NPH/LAA) insulin)

D

Post-operative period – usual insulin doses (including an optional additional 25% if hyperglycaemic) as soon as eating re-commences
        

Patient s using oral medications will generally omit on the day of a procedure and re-start once post operative with occasional ‘one-off’ supplementary insulin peri-operatively if hyperglycaemic.

If pre-op plans do not effectively control glucose levels intravenous therapy with Glucose / Insulin / Potassium therapy may be indicated – if required this will generally delay discharge by 12-36 hours.

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