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Patients with diabetes treated with insulin undergoing surgery

You are due to have an operation which will mean that you will be asked to omit at least one meal. This leaflet gives advice about what you should do about your diabetes treatment before and after the surgery.

 

Before your operation

Please follow the instructions below

 

If your operation is in the morning:

 

  • Do not take any food or drink other than water from 6 hours before the time you are asked to come to hospital.

 

  • You may drink water until 2 hours before you come to hospital.

 

If your operation is in the afternoon:

 

  • Eat breakfast before 7.00am and take no food or drink other than water after this time.

 

 

  • You may drink water until 2 hours before you come to hospital.

 

  • When you travel to and from the hospital for your operation carry some glucose tablets or a sugary drink to take if your blood sugar is low.

 

If you have any symptoms of a low blood glucose such as sweating, dizziness, blurred vision or shaking please test your blood glucose if you are able to do so.

 

If it is less than 4 mmol/L take 4 glucose tablets or 150mls of the sugary drink (this is the same as half a standard sized can of non-diet cola). Please tell staff at the hospital that you have done this because it is possible that your surgery may have to be re-arranged for another day.

 

Things to bring with you

Remember to bring with you to hospital:

 

  • Glucose tablets or a sugary drink.

 

 

  • Blood glucose testing equipment you usually use.

 

  • Insulin you usually take for your diabetes, labelled with your name.

 

During your operation

If you are likely to miss more than one meal or if your blood glucose is high at the time of the operation you may be given an intravenous insulin infusion (a combination of insulin and fluid given into a vein). This will be continued until you are ready to eat and drink and will be discontinued once you have taken your usual insulin.

 

After your operation

After your operation your blood glucose will be checked and additional insulin given if necessary

 

  • After your operation you will be offered food and drink when you feel able to eat. If you are eating and drinking normally you should restart your normal insulin (see guidance on pages 3-4). However, your blood glucose levels may be higher than usual for a day or so

 

 

  • When you get home, if you feel nauseated or vomit and are unable to eat, please refer to the sick day rules below.

 

  • If you do not improve quickly and usually attend the hospital for diabetes care please telephone the Diabetes Team on (01536) 492121 or (01604) 545930 during office hours Monday - Friday. Outside these hours please contact your GP practice or out of hours service. If you usually see your GP about your diabetes please phone your GP practice.

 

What do do with your insulin before surgery

 

Once daily (evening) (e.g. Lantus®, Levemir®, Tresiba®, Insulatard®, Humulin I®, Insuman Basal®)

Reduce your dose by 20% on the day prior to surgey. On the day of your surgey (AM or PM), your blood glucose will be checked on admission.

 

Once daily (morning) (e.g. Lantus®, Levemir®, Tresiba®, Insulatard®, Humulin I®, Insuman Basal®)

Reduce your dose by 20% on the day prior to surgey. On the day of your surgey (AM or PM) reduce your dose by 20%, your blood glucose will be checked on admission.

 

Twice daily (Novomix 30®, Humulin M3®, Humalog Mix25®, Humalog Mix50®, Insuman comb 25®, Insuman comb 50®, twice daily Levemir®, or Lantus®)

Do not change your dose on the day prior to surgey. On the day of your surgey (AM or PM), halve the usual morning dose. Your blood glucose will be checked on admission. Leave the evening meal dose unchanged.

 

Twice daily – separate injections of short- acting (e.g. animal neutral, NovoRapid®, Humulin S®)

Apidra® and intermediate-acting  (e.g. animal isophane, Insulatard®, Humulin I®, Insuman®)

Do not change your dose on the day prior to surgey. On the day of your surgey (AM or PM), calculate the total dose of both morning insulins and give half as intermediate-acting only in the morning. Your blood glucose will be checked on admission. Leave the evening meal dose unchanged.

 

3, 4 or 5 injections daily (e.g. an injection of mixedinsulin 3 times a day or 3 meal time injections of short-acting insulin and one or twice daily background)

Do not change your dose on the day prior to surgey. 

 

On the day of surgery, If your surgery is in the morning (AM): 
Basal bolus regimens: Omit the morning and lunchtime short-acting insulins. If you usually take a long-acting basal insulin in the morning then you should reduce this dose by 20%.

Pre-mixed a.m. insulin: Halve the morning dose and omit lunchtime dose. Your blood glucose will be checked on admission.

 

On the day of surgery, If your surgery is in the evening (PM): 

Take usual morning insulin dose(s). Omit lunchtime dose. Your blood glucose will be checked on admission.

 

You should resume taking your insulin as usual the morning after surgery. Your blood glucose may be higher than usual for a day or so.

 

Sick day rules

 

What should I do if I am unwell?

 

  • NEVER stop taking your insulin or tablets - illness usually increases your body's need for insulin.
  • Test your blood glucose level every two hours, day and night.
  • Test your urine for ketones every time you go to the toilet or your blood ketones every 2 hours if you have the equipment to do so.
  • Drink at least 100ml water/sugar free fluid every hour - you must drink at least 2.5 litres per day during illness (approx. 5 pints!).
  • Rest and avoid strenuous exercise as this may increase your blood glucose level during illness.

  • Eat as normally as you can. If you cannot eat or if you have a smaller appetite than normal, replace solid food during illness, with one of the following:

    • 400mls milk
    • 200mls carton fruit juice
    • 150 - 200mls non-diet fizzy drink
    • 1 scoop ice cream

 

When should I call the Diabetes Specialist Nurses or my GP?

  • Continuous diarrhoea and vomiting, and/or high fever.

  • Unable to keep down food for 4 hours or more.

  • High blood glucose levels with symptoms of illness (above 15mmol/L - you may need more insulin).

  • KETONES at ++2 or +++3 in your urine or 1.5mmol/L blood ketones or more. (You may need more insulin). In this case, contact the person who normally looks after your diabetes immediately.

 

Outside normal working hours consult the local out of hours service or go to your local hospital A&E department.

 

Discharge advice

Take your Insulin or other medication as advised. 

  • Monitor your blood glucose if you have the equipment to do so - 4 times per day if possible. You should test more frequently if you are unwell, feeling or being sick. 

  • Your blood glucose may be higher than usual. This is not a concern if you are feeling well. 

  • If you are feeling unwell (particularly if you are being sick and unable to take food or medication) contact your usual diabetes team/GP surgery.

  • If outside of normal working hours contact the out of hours service. 

 

Other information 

Northampton General Hospital operates a smoke-free policy. This means that smoking is not allowed anywhere on the Trust site, this includes all buildings, grounds and car parks. Leaflets, information, advice and support on giving up smoking and on nicotine replacement therapy are available from the local Stop Smoking helpline on 0845 6013116, the free national helpline on 0300 123 1044, email: smokefree@nhft.nhs.uk and pharmacies.

 

Car parking at Northampton General Hospital is extremely limited and it is essential to arrive early, allowing ample time for parking. You may find it more convenient to be dropped off and collected.

 

This information can be provided in other languages and formats upon request including Braille, audio cassette and CD. Please contact (01604) 523442 or the Patient Advice & Liaison Service (PALS) on (01604) 545784, email: pals@ngh.nhs.uk.

 

Last updated May 2019

NGV1541

 

 

 

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