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You’re preparing a diabetic patient for surgery. Their morning glucose reads 300 mg/dL…—should you proceed?
Perioperative glucose control is one of the most critical aspects of surgical safety. Poor control increases the risk of infection, delayed wound healing, and other complications that can derail recovery.
💡 Why Blood Sugar Control Matters
Surgery triggers stress hormones, fasting, and altered insulin sensitivity—all leading to major glucose fluctuations.
Hyperglycemia contributes to:
- Surgical site infections (impaired white cell function)
- Poor wound healing
- Cardiovascular events (especially in patients with CAD)
- Osmotic diuresis and dehydration
- Acute kidney injury
Even a few hours of perioperative hyperglycemia can worsen outcomes.
⚠️ Don’t Forget Hypoglycemia
“Too high” isn’t the only problem—too low can be just as dangerous.
During anesthesia, autonomic warning signs like sweating or tremors are often masked, making hypoglycemia hard to detect. It may present as bradycardia, hypotension, or even seizures, mimicking other anesthetic complications.
Common triggers include:
- Prolonged fasting
- Oral hypoglycemic agents (especially sulfonylureas)
- Excessive insulin dosing
Avoid overcorrection—aim for stability, not perfection.
⚙️ Target Range and Practical Management
Most guidelines recommend maintaining glucose between 140–180 mg/dL during the perioperative period.
This range minimizes both hyperglycemic and hypoglycemic risks—a “safe middle ground” rather than tight control.
✅ Practical Tips (with Notes)
- Pre-op: Check HbA1c when possible.
Discontinue oral hypoglycemics according to their pharmacology—e.g., SGLT2 inhibitors several days before, metformin or sulfonylureas the day prior. (Details vary by drug; see dedicated post.) - Intra-op: Use IV insulin infusion for major surgeries with glucose checks every 1–2 h.
For smaller procedures, Sliding Scale Insulin (SSI) may be used—but in elderly or renally impaired patients, SSI can easily cause hypoglycemia, so continuous monitoring is safer. - Post-op: Continue frequent monitoring until oral intake resumes.
Watch for rebound hypoglycemia as stress hormone levels normalize.
Early coordination with endocrinology is essential for insulin pump users—individualized planning prevents surprises.
📝 Take-Home Message
- Keep perioperative glucose steady between 140–180 mg/dL.
- Prevent infection and delayed healing by avoiding hyperglycemia—but also watch for masked hypoglycemia under anesthesia.
- Adjust oral agents appropriately and use sliding scales judiciously.
- Balance—not tight control—is the key to safe anesthesia and smooth recovery.
📚 References & Further reading
- American Diabetes Association (ADA) “Standards of Medical Care in Diabetes—2024”：2024;47(Suppl 1):S295-S304.
- Society for Ambulatory Anesthesia. Updated Consensus Statement on Perioperative Blood Glucose Management in Adult Patients With Diabetes Mellitus Undergoing Ambulatory Surgery. Anesth Analg. 2024 Aug;
- Joint British Diabetes Societies Guidelines, NICE guidelines (UK)
- NICE-SUGAR trial (NEJM, 2009)
🔗 Related articles
- to be added.