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• type (oral antidiabetics and/or insulin) and dose of antidiabetic therapy in use;
• frequency and symptoms of hypoglycemia;
• the blood glucose level at which hypoglycemic symptoms occur;
• hospital admissions that have come about from glycemic control issues; and
• the patient's ability to test blood glucose levels.
Diabetic patients should land as early in the schedule as possible, so they
fast for less than 12 hours and miss no more than 1 meal.
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Pre-operative therapy
Hypoglycemia isn't generally a worry in patients on oral antidiabetics; it
occurs only rarely with sulfonylureas, meglitinides and non-insulin injectables. Patients should continue use of these drugs, including metformin, until
the day before — but not on the day of — surgery.
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Pre-operative patient preparation
Provide patients with instructions for handling their insulin regimens
leading up to surgery (see table for dosing-instruction guidelines). Instruct
them to bring all their diabetes medications, including insulin, with them on
the day of surgery, and to travel with glucose tablets or a sugary drink in case
of post-op hypoglycemia. When the patient arrives, make sure she hasn't consumed the tablets or drink en route, nor anything else barred by your general
NPO instructions.
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Pre-operative decision to proceed
There isn't a specific pre-op blood glucose level above which surgery
O C T O B E R 2012 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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