Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Management of patients with diabetes mellitusManagement of patients withdiabetes mellitusPatients on the surgical day unit[Dr Robin Correa, Sonya West and Sandy Nightingale; appraised by RC,January 2010]According to the British Association of Day surgery (BADS) diabeticpatients have historically been excluded from day surgery because offears regarding control of their blood glucose levels during theperioperative period. The fact that the patient will be fasting and thenundergoing anaesthesia which was associated with postoperativenausea and vomiting led to the belief that patients can becomedestabilised and are at risk. However there have been changes in themodern day way of thinking and BADS are quoted with the following:-• “Modern day surgery anaesthesia is associated with fasterrecovery so that oral intake is usually rapidly re-established.• Postoperative emetic symptoms are now uncommon.• More patients are able to monitor their own blood sugar andtake an active part in managing their own diabetes.These considerations mean that many diabetic patients can now betreated safely on a day basis” (BADS 2005).Criteria for the treatment of diabetic patients on the Surgical Day Unit1. All patients to be pre-assessed2. Optimized glycaemic control (HbA 1C level < 8)3. No history of• Angina, myocardial infarction.• Renal failure.Anaesthetists Handbook January 2010 155