Effect of basal insulin dosage on blood glucose concentration in ambulatory surgery patients with type 2 diabetes

Demma, Linda J.; Carlson, Karen; Duggan, Elizabeth W.; Morrow, John Gordon; Umpiérrez, Guillermo E.

doi:10.1016/j.jclinane.2016.10.003

Cited by 42 publications

(35 citation statements)

References 16 publications

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“…A review found that perioperative glycemic control tighter than 80-180 mg/dL (4.4-10.0 mmol/L) did not improve outcomes and was associated with more hypoglycemia (70); therefore, in general, tighter glycemic targets are not advised. A recent study reported that, compared with the usual insulin dose, on average an approximate 25% reduction in the insulin dose given the evening before surgery was more likely to achieve perioperative blood glucose levels in the target range with decreased risk for hypoglycemia (71).…”

Section: Perioperative Carementioning

confidence: 99%

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

188

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. In the hospital, both hyperglycemia and hypoglycemia are associated with adverse outcomes, including death (1,2). Therefore, inpatient goals should include the prevention of both hyperglycemia and hypoglycemia. Hospitals should promote the shortest safe hospital stay and provide an effective transition out of the hospital that prevents acute complications and readmission. For in-depth review of inpatient hospital practice, consult recent reviews that focus on hospital care for diabetes (3,4). HOSPITAL CARE DELIVERY STANDARDS Recommendation 15.1 Perform an A1C on all patients with diabetes or hyperglycemia (blood glucose .140 mg/dL [7.8 mmol/L]) admitted to the hospital if not performed in the prior 3 months. B High-quality hospital care for diabetes requires both hospital care delivery standards, often assured by structured order sets, and quality assurance standards for process improvement. "Best practice" protocols, reviews, and guidelines (2) are inconsistently implemented within hospitals. To correct this, hospitals have established protocols for structured patient care and structured order sets, which include computerized physician order entry (CPOE). Considerations on Admission Initial orders should state the type of diabetes (i.e., type 1 or type 2 diabetes) or no previous history of diabetes. Because inpatient insulin use (5) and discharge orders (6) can be more effective if based on an A1C level on admission (7), perform an A1C test on all patients with diabetes or hyperglycemia admitted to the hospital if the test has not been performed in the prior 3 months (8). In addition, diabetes self-management knowledge and behaviors should be assessed on admission and

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Section: Perioperative Carementioning

confidence: 99%

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

188

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“…İnsülinin bazal gereksiniminin %50'si hipoglisemiye neden olmadan metabolik gereksinimleri karşılamak için gereklidir ve ketozu önlemek için açlık durumunda da alınmalıdır (24) . Cerrahi sabahı hastaların kan şekerlerini inceleyen gözlemsel bir çalışma, akşam bazal insülin tedavisini almayan hastaların, bazal insülin dozunun %50-75'ini alanlara göre önemli ölçüde daha yüksek kan şekeri seviyelerine sahip olduğunu; bazal insülin almayan hastaların ortalama 274 mg dL -1 (15.2 mmol L -1 ) kan şekeri seviyesi ile ameliyat için başvurduğunu ortaya koymuştur (25) .…”

Section: Farmakolojik Tedavi Yönetimiunclassified

“…Ameliyattan önceki akşam uzun etkili insülin dozunun %20-25 azaltılması (10,25) , NPH ve miks insülinin ameliyattan önceki akşam normal dozun %80'inde dozlanması, açlık başladığında prandial insülinin atlanması hipoglisemi olmadan hiperglisemiyi önlemek amacıyla önerilmektedir (15) .…”

Section: Farmakolojik Tedavi Yönetimiunclassified

Peroperative Period with Diabetes Mellitus

Ceran¹,

Polat²

2020

jarss

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Diabetes mellitus en yaygın kronik hastalıklardan biridir. Ameliyat edilecek hastaların %25'i diabetes mellitus tanısı almış kişilerdir. Hiperglisemisi olan bireylerin peroperatif değerlendirilmesi hem anestezik yönetim hem de hastanın yaşam kalitesini belirleyecek önemdedir. Bu derlemede, diyabetin fizyopatolojisi, tanı kriterleri, farmakolojik ve peroperatif değerlendirilmesi ve yönetiminden söz edilmiştir.

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“…If the patient uses an insulin pump, it is appropriate for them to continue their basal insulin and if needed bolus insulin can be administered as blood sugar levels necessitate [25]. In patients whose basal rate is calculated to keep the blood glucose in normal or low-normal ranges or when there is history of low glucose measures as an outpatient, patients may reduce the dose of long-acting basal insulin by 20-25% the evening before surgery to avoid any chance of preoperative hypoglycemia [25,26]. If they routinely take basal insulin only in the morning, then the reduced dose should instead be administered on the morning of surgery [25].…”

Section: Insulinmentioning

confidence: 99%