Adult Medical Emergency Handbook - Scottish Intensive Care Society

Continuing Care
• Ensure patient is reviewed by the diabetes team prior to discharge,
so that the cause of the HONK can be elucidated, appropriate
education be given and follow up arranged.
• Patient should not be discharged until biochemically normal,
eating normally and established on appropriate therapy.
• Ensure that a copy of the discharge summary is sent to the
diabetes team.
HYPOGLYCAEMIA
PERI-OPERATIVE MANAGEMENT OF DIABETIC PATIENTS
General Principles
Plan Ahead
Admit 1 day before elective surgery for:
• full assessment of risk factors, baseline biochemistry, glucose
profile, ECG.
• optimisation of metabolic control
• formulation of peri-operative management plan with Diabetic
Registrar
• Schedule the patient for surgery (whenever possible) early in the
morning and first on the list.
• Discuss all patients with the anaesthetist and remember that the
Diabetes Team are ALWAYS available to give you help/advice (Page
#6800 RIE, WGH via switchboard, SJH Diabetes consultants).
• If patients have poor metabolic control but require emergency
surgery, discuss with the Diabetes Team.
WHICH PATIENTS NEED PERI-OPERATIVE INSULIN?
• All outpatients being treated with insulin
• All patients having major surgery (most abdominal and thoracic
procedures)
• Any traumatic procedure especially in poorly controlled patients
• All patients undergoing emergency surgery
• All who are acutely ill
HOW SHOULD THE INSULIN BE ADMINISTERED?
GKI or Sliding Scale
The precise method should be discussed with the anaesthetist but is
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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