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Date issued: July 2022

Review date: July 2024

Ref: F-67/CG/Diabetes/Diabetes advice for planned operations or procedures

PDF:  Diabetes advice for planned operations or procedures final July 2022.pdf [pdf] 219KB

Advice for people with diabetes who are coming into hospital for planned operations or procedures

You have been given this booklet because you have diabetes and are having a planned operation or procedure at Derriford Hospital or a partner site.

Follow the fasting instructions you have been given with your letter or at your pre-operative assessment appointment. Please see the next two pages for advice on managing your diabetes medications for surgery.

When you travel to and from the hospital carry some glucose tablets/gel or a sugary drink. If you have any symptoms of a low blood sugar such as sweating, dizziness, blurred vision or shaking please test your blood sugar if you can do so. If it is less than 6mmol/L take 4 glucose tablets or 150ml of the sugary drink (this is the same as half a standard sized fizzy drink can). Please tell staff at the hospital that you have done this when you arrive.

Remember to bring with you to hospital

• The medications and any equipment you usually need for your diabetes.

• Blood glucose testing equipment (if you usually monitor your blood glucose).

• Glucose tablets and/or a sugary drink.

If you use a wearable glucose sensor this can usually remain in place for surgery. Please bring a spare sensor with you in case it is removed for any reason. The diabetes team are unable to provide sensors.

After your operation you will be offered food and drink when you feel able to eat. After day surgery, if you are eating and drinking normally you should resume taking your normal medication the next day. However, your blood glucose levels may be higher than usual for a day or so.

If you have any concerns and need further information, you can contact the Diabetes Specialist Nurses on 01752 430388, Please leave a message with your name, hospital number and the date of your surgery and we will aim to return your call within 24 – 48 hours (excluding weekends and bank holidays).

If you are staying in Hospital after your operation

If you are staying in hospital after your operation, we believe it is important that you manage your diabetes if you are well enough to do so. You can test your blood glucose whenever you want to. However, to promote safe care we will also take blood glucose tests using the hospital’s meters. These are very accurate and are linked to the hospital Wi-Fi and enable the diabetes specialists to identify patients who are experiencing out of range results.

If you use insulin, you may be able to self-inject and decide on your own insulin dose. Please agree this with the ward nurse so that it can be recorded on your medication record.

In hospital you should aim for blood glucose values between 6 and 12 mmol/L. do not worry if your readings are occasionally outside this range but if they are consistently outside this range ask your ward nurse to contact the diabetes specialist team.

After you are discharged from hospital

• When you get home, if you feel nauseated, are vomiting and/or are unable to eat, please refer to the sick day rules   leaflet

• If you do not improve quickly and usually attend the hospital for diabetes care, please telephone the Diabetes Team on (01752 430113) during office hours Monday –          Friday. Outside these hours or if you usually see your GP about your diabetes, please contact your GP practice or out of hours service on 111.

What to do with your medication before surgery

Tablets or GLP-1 injections

After your operation you should be able to restart your medications when you are eating and drinking normally again. This may be a few days after your operation and intravenous insulin may be used in the meantime.

Tablets or GLP-1 injections

Diabetes Medication	Day before surgery	Timing of surgery
		Morning surgery	Afternoon surgery
Acarbose	Take as normal	Do not take morning dose if not eating	Take morning dose if eating
Meglitinide Repaglinide	Take as normal	Do not take morning dose if not eating.	Take morning dose if eating.
Metformin If contrast medium is to be used do not take on the day of the procedure and for the following 48 hours	Take as normal	If taken once or twice a day – take as normal If taken three times a day – do not take lunchtime dose	If taken once or twice a day – take as normal If taken three times a day – do not take lunchtime dose
Sulphonylurea Gliclazide, Glibenclamide, Glipizide, Glimiperide	Take as normal	Do not take on morning of surgery If taken twice daily, take evening dose if eating	Do not take on day of surgery
Pioglitazone	Take as normal	Take as normal	Take as normal
DPP4 inhibitor         Sitagliptin, Vildagliptin, Saxagliptin, Alogliptin, Linagliptin	Take as normal	Take as normal	Take as normal
GLP-1 Receptor Agonist daily/weekly injection Liraglutide, Semaglutide, Dulaglutide, Exenatide, Lixisenatide	Take as normal	Take as normal	Take as normal
SGLT-2 inhibitors Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin	Do not take on day before surgery	Do not take on day of surgery and if staying in hospital omit until eating and drinking normally for 48 hours	Do not take on day of surgery and if staying in hospital omit until eating and drinking normally for 48 hours

What to do with your medication before surgery

Insulin treated diabetes

This is a guide to help you adjust insulin doses before surgery, it will not suit everyone. Please contact the diabetes nurses on 01752 430388 for more specific advice.

If you are taking more than one type of insulin, please follow the guidance for each type.  If you are having bowel surgery or following a special diet before surgery the instructions may be different, please contact the planned surgery diabetes nurses for more advice.

On the day of your surgery, from 6am you should monitor your blood glucose every 2 hours before you arrive at the hospital. If you are driving to the hospital, you should only drive if your blood glucose is more than 5mmol/L.

If your surgery is longer than two hours or you are likely to miss two or more meals it may be necessary to use intravenous insulin therapy, the anaesthetic team and diabetes team can give you more information about this on the day.

Insulin treated diabetes

Name of insulin	Day before surgery	Day of surgery
		Morning surgery	Afternoon surgery
LONG ACTING INSULINS Abasaglar, Humulin I, Insulatard, Insuman Basal, Lantus, Levemir, Toujeo, Tresiba, Semglee,
Once-daily long-acting (morning)	Take as usual	Reduce your dose by 20%   Restart your usual dose the following day	Reduce your dose by 20%   Restart your usual dose the following day
Once daily long-acting (lunchtime)	Reduce dose by 20%	Restart insulin at normal dose when eating and drinking starts	Restart insulin at normal dose when eating and drinking starts
Once daily long-acting (evening)	Reduce dose by 20%	No dose adjustment necessary	No dose adjustment necessary
Twice daily long-acting insulin	Morning dose as usual Evening dose reduce by 20%	Reduce morning dose by 20%   Continue usual evening dose	Reduce morning dose by 20%   Continue usual evening dose
PRE-MIXED INSULINS Humulin M3, Humalog Mix25, Humalog Mix 50, Novomix 30, Hypurin Porcine 30/70 mix, Insuman Comb 25, Insuman Comb 50
Twice daily pre-mixed insulin	Take as usual	Take half the usual morning dose.   Resume usual insulin with evening meal if eating a normal meal. If eating a small meal halve the dose	Take half the usual morning dose.   Resume usual insulin with evening meal if eating a normal meal. If eating a small meal halve the dose

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Short or rapid acting mealtime insulin

SHORT OR RAPID ACTING MEALTIME INSULIN Actrapid, Apidra, NovoRapid, Humalog, Humulin S, Fiasp, Hypurin Porcine Neutral, Insuman Rapid, Lyumjev
One to three times per day with meals	Take as usual	Do not take if not eating a meal Restart normal insulin dose with next meal, reduce the dose if eating less than usual	Take usual dose with breakfast if eating Restart normal insulin dose with next meal, reduce the dose if eating less than usual
Insulin Pump Therapy
You should be able to continue to use your pump if your procedure requires you to miss no more than one meal. If your operation takes longer than two hours, it will be necessary to have intravenous insulin until you are eating again. Reduce your basal rate before you come into hospital if you think you may have hypoglycaemia when you are not eating. Bring your alternative basal and mealtime insulin pens into hospital with you in case you are unwell and not able to manage your pump after your operation.