Overview

This topic covers the periprocedural management of an adult with type 1 diabetes. Clinical practice guidelines for periprocedural management of a child or adolescent with diabetes are available from The Royal Children’s Hospital website.

Managing an adult with type 1 diabetes undergoing a procedure depends mainly on:

  • anticipated duration of fasting
  • preprocedural blood glucose concentrations
  • duration and complexity of the procedure.

If the procedure is long and complex (eg coronary bypass graft), patients with type 1 diabetes should be managed with an intravenous insulin infusion running concurrently with an intravenous glucose infusion. Follow local hospital protocol.

If the procedure is not long and complex, patients with type 1 diabetes can usually continue their usual basal insulin (either by subcutaneous injection or CSII pump); an intravenous insulin infusion is generally not needed. Follow local hospital protocols if available. Preferably, the procedure should be first on the morning list.

Basal insulin should be continued periprocedurally for all patients with type 1 diabetes (even when fasting) unless an intravenous insulin infusion has been started. Withholding a basal insulin dose or stopping the basal rate of a continuous subcutaneous insulin infusion (CSII) pump without starting an intravenous insulin infusion will lead to ketosis. CSII pumps only deliver rapid-acting insulin (not long-acting insulin); if a CSII pump is stopped, the patient quickly becomes insulin deficient (within 2 to 3 hours) and is at high risk of diabetic ketoacidosis.

Note: Do not withhold basal insulin in patients with type 1 diabetes unless an intravenous insulin infusion is started.

For patients undergoing a nonurgent procedure who have significant ketosis or evidence of dehydration from hyperglycaemia, postpone the procedure until the patient is metabolically stable. If the procedure cannot be delayed, fluid replacement and management of ketosis with an intravenous insulin infusion should be undertaken at the same time as the procedure.

After a procedure, patients with type 1 diabetes should have frequent blood glucose concentration monitoring (see Postprocedural management of adults with type 1 diabetes). Blood ketone concentration should be checked in any medically unstable patient or when prolonged fasting occurs.

For patients undergoing a diagnostic bowel procedure or bowel surgery, see Management of adults with type 1 diabetes who require bowel preparation.