Perioperative Management of Diabetes Mellitus
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- Insulin does not lower blood glucose, it just prevents it from going up.
- Sliding scale = BAD because it is reactive and can lead to insulin stacking, and possibly hypoglycemia.
- Inpatients should hold oral medications (e.g. Metformin) 24 hrs prior to surgery, continue nasal insulin.
- Ambulatory patients are ok to continue with oral medications prior to surgery.
- Check ketones for BG > 250 prior to surgery.
- If patient is insulin naive and intraop BG > 180, can give small doses of rapid-acting insulin.