Management of adults with type 1 diabetes who are fasting before a procedure

insulin management

BGC monitoring

hyperglycaemia management

hypoglycaemia management

hydration maintenance

Continue basal insulin (either long-acting basal insulin or basal rate of rapid-acting insulin by CSII pump).

Omit mealtime rapid- or short-acting bolus insulin while fasting.

Measure hourly from waking or from the time of the first missed meal.

Measure more frequently if results are outside the target range.

Target range is usually 5 to 10 mmol/L, or higher if the patient has hypoglycaemia unawareness.

If BGC is high (more than 12 mmol/L), give a supplemental (correction) dose of rapid-acting insulin. Wait at least 4 hours before giving a further supplemental dose to avoid insulin stacking and subsequent hypoglycaemia [NB2].

If BGCs remain high, or if feeling unwell, check blood ketone concentration and follow the written instructions or seek medical assistance [NB3].

For hypoglycaemia when fasting for a procedure (BGC less than 5 mmol/L):

• take glucose gel or tablets or, if able to take fluid, a glass of clear apple juice or sugar-containing cordial
• measure BGC every 15 minutes until BGC increases to more than 5 mmol/L.

If repeated episodes of hypoglycaemia or persistent hypoglycaemia occur with developing ketosis, seek urgent medical assistance.

Drink water while oral fluids are allowed.

Do not drink glucose-containing fluids (eg clear apple juice) unless needed to treat hypoglycaemia.

If intravenous fluid is given before a procedure, glucose-containing solution should only be given for hypoglycaemia or for management of developing ketosis (when given by intravenous infusion with extra insulin to clear ketones).