Table 3.45.

Management of diabetics requiring general anaesthesia

	Non-insulin-dependent diabetics*	Non-insulin-dependent diabetics	Insulin-dependent diabetics
Procedure	Minor operations, e.g. few extractions	Major operations, e.g. maxillofacial surgery	Any operation
Preop	Stop biguanides. If on chlorpropamide, change to tolbutamide 1 week preop	Stabilise on at least b.d. insulin for 2–3 days preop One day preop use only short-acting insulin (Actrapid soluble or neutral)
Periop	Omit oral hypoglycaemic Estimate blood glucose level	Do not give sulphonylurea or subcutaneous insulin on day of operation Estimate blood glucose level Set up intravenous infusion of 10% glucose 500 mL containing Actrapid or Leo neutral insulin 10 units plus KCl 1 g at 8.00a.m. Infuse over 4 h Estimate blood glucose and potassium levels 2-hourly Adjust insulin and potassium to keep glucose at 5–10 mmol/L and the patient normokalaemic
Postop	Estimate blood glucose 4 h postop	Continue infusion 4-hourly Estimate blood glucose 4-hourly Estimate potassium 8-hourly
On resuming normal diet	Start sulphonylurea or other usual regimen	Stop infusion Start Actrapid or Leo neutral insulin and over the next 2 days Start sulphonylurea Start normal insulin regimen

^*If well controlled, otherwise treat as insulin-dependent.