Diabetes

 

Complications:

Macrovascular

·      IHD

·      CVD

·      PVD

Microvascular

·      Nephropathy

·      Retinopathy

·      Peripheral neuropathy

·      Autonomic neuropathy (incl blood pressure lability, gastroparesis)

(also: immunosuppression)

 

Pre-op issues:

Investigations

Diabetes:

·      BSL regularly while fasting

·      Ketones (<0.6)

·      HbA1c (<9%)

Complications:

·      UEC (? Creatinine)

·      ECG (? IHD)

Treatment

·      Metformin: 24 hours if major, day of surgery if minor

·      Sulfonylurea: day of surgery

·      Flozins: 72 hours if major, day of surgery if minor

·      Other OHA: day of surgery

·      Insulin: give half dose as protaphane