Perioperative Management of Diabetes Mellitus

• 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.