Type 2 diabetes mellitus
Patient (condition)
 
Aliases:
NIDDM
type II diabetic
type 2 diabetic
type 2 diabetes
type II diabetes

Topic aliases are alternate phrasings for a particular topic.


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Long acting insulins can usually be continued in normal dosage perioperatively

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Dec 04, 2011
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Patients having major surgery will likely require insulin supplementation
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Nov 18, 2012
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Withhold metformin and glibenclamide 24hrs prior to surgery.
SGLT2 inhibitors may need to be witheld for 3 days prior to surgery to minimise risk of Euglycaemic diabetic-ketoacidosis. Check local guidelines.
Other oral hypoglycaemics can continue to morning of surgery.
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Apr 24, 2019
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Book first on operating list where possible to minimise fasting time

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Sep 13, 2011
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For major surgery, a BSL >270g/dL (15mmol) requires delay & rapid preop stabilisation refl.in/3y

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May 18, 2011
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For major surgery, BSL >400g/dL (22mmol) requires postponement & correction of metabolic derangement refl.in/3y

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May 18, 2011
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Those with poor long term glucose control are at risk of autonomic neuropathy and accompanying gastroparesis/delayed gastric emptying. These patients are therefore at an elevated risk of gastric regurgitation and pulmonary aspiration, so have a low threshhold for intubating if requiring general anesthesia, and do so in a manner than minimises the risk of aspiration at induction (eg RSI)

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Nov 18, 2012
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May have autonomic dysfunction and impaired response to hypotension from anaesthesia/IPPV/postural change.

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May 18, 2011
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Preop, intraop (if prolonged surgery), and recovery blood sugar levels aiming for a BSL 6-10 mmol/L

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Nov 18, 2012
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If the patient is taking metformin they are risk of metformin associated lactic acidosis (MALA). (particularly those who are elderly, septic, hypovolaemic, or have renal impairment)
refl.in/14 refl.in/15

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Mar 09, 2012
Withhold metformin perioperatively. refl.in/14
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Perioperative steroids (eg dexamethasone) may elevate blood glucose. Consider alternative anti-emetics or if required, ensure adequate perioperative blood glucose monitoring.

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Oct 21, 2012
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