June 28, 2002
Question from Auburn, Washington, USA:
My son is scheduled to have orthopedic surgery in the afternoon. Will he have to fast all day before the surgery? If so how do we handle his insulin and blood sugars?
This is little hard to answer for you specifically as I think we’re missing vital information such as: what is his usual doses of insulin during the day?
In very general terms, I ask my surgery colleagues to schedule my patients who have diabetes as the first case of the day, if at all possible so as to minimize fasting, changed insulin, etc. If your son is on basal/bolus therapy (either with an insulin pump or with multiple daily injections [MDI] using Lantus (insulin glargine) or Ultralente as the basal insulin, and Regular, Humalog or Novolog as the bolus insulin, then probably little needs to be done in terms of insulin adjustments. Allow him to maintain his usual baseline doses. If he is on combinations such as NPH or Lente morning plus Regular/Humalog/Novolog routinely in the morning, then often the short-acting insulin is held and the dose of intermediate acting insulin should be decreased – sometimes by near 50-66%. The anesthesiologists will certainly want to monitor the blood glucose periodically during and after the procedure and will want to be in touch with your son’s diabetes doctor.
Generally, patients need only fast for about eight hours before an operation. So, most of the time, for the first case of the day, they are given instructions to simply have nothing to eat after midnight. This should not interfere with your son’s insulin doses the day before the operation. Depending on his comfort/pain level, and degree of sedation after the operation, and the use of intravenous fluids that might contain glucose, extra insulin may need to be individualized for the day or so following the procedure.
These questions are best answered by your child’s primary diabetes team with a general plan discussed amongst the various physicians to coordinate things before the operation. Keep a good dialogue.
[Editor’s comment: Also see Surgery Pre-Op Advice at the Diabetes Monitor for some additional thoughts.