Considerations for Care: Blood Sugar Management for Type 1 Diabetics Undergoing Surgery

MEDICAL NUTRITION THERAPYDIABETES
Written By Guest User

by Megan Taylor, RD, associate at On the Brink Nutrition Collective

When preparing for surgery, Type 1 diabetics need to take special precautions to manage their blood sugar levels. Surgery and anesthesia can significantly impact glucose levels, so it’s crucial to follow a plan tailored to your individual needs. Here are some key considerations to keep in mind before, during, and after surgery to help manage your diabetes effectively.

Preoperative Recommendations

The Week Before Surgery:

  • Monitor Your Blood Sugar Closely: Follow your diabetes treatment plan closely in the week leading up to surgery. Test your blood glucose before each meal and at bedtime. Keeping a detailed record of your blood glucose levels is important. If you use a Continuous Glucose Monitor (CGM), make sure to bring a week's worth of data with you on the day of your surgery.

  • Communicate with Your Surgical Team: Inform your surgical team that you use a CGM, explain how it works, and show them how to access the data on your phone. It’s also important to know that you typically do not need to remove your CGM before or during surgery. Ensuring that everyone is aware of this can help maintain consistent monitoring of your blood glucose levels.

Blood Sugar and Insulin Recommendations:

  • Day of Surgery: If your blood glucose is less than 200 mg/dL on the day of surgery, do not take any insulin before arriving at the hospital. An Accucheck will be performed upon arrival to ensure you are within a safe range.

  • Insulin Dosing: To prevent hypoglycemia, it is recommended that you take 80% of your usual basal insulin dose the night before and the morning of surgery. For example, if your regular long-acting insulin dose is 52 units, you would take about 41-42 units. Also, stop taking prandial (mealtime) insulin once you start fasting for surgery. If your surgery is scheduled for the afternoon, you may take a reduced dose of short-acting insulin before a light breakfast and around noon, even without food. Frequent blood glucose monitoring is crucial, especially in the week leading up to surgery, to adjust your insulin regimen as needed. If your blood sugar drops below 50 mg/dL, use a fast-acting glucose source like juice, glucose tablets, or sugar to raise it quickly.

Medications:

  • Adjusting Insulin and Oral Medications: Continue to take your diabetes medications as prescribed, but consult your healthcare provider about any necessary adjustments, especially for long-acting insulin and oral agents. If you are taking an ultra long-acting insulin like Tresiba, which can last up to 42 hours, discuss with your endocrinologist when your last dose should be based on the timing of your surgery.

Eating and Drinking:

  • Fasting Guidelines: Eat a final snack at least eight hours before your surgery and then stop eating. You may continue to drink sugar-free, clear fluids like water, black coffee, or plain tea. Confirm with your provider about how long they want you to fast before surgery.

Additional Considerations

  • Post-Surgery Blood Sugar Management: Be aware that pain medications or steroids given after surgery may cause your blood sugar to run higher than usual. This is a common reaction and does not mean you have done anything wrong. Stress and pain can also contribute to elevated blood sugar levels.

  • Advocate for Your Needs: Remind everyone involved in your care that you have Type 1 diabetes, not Type 2, and that your needs are different. Make sure the surgical team knows how to use your CGM and understands the importance of not removing it. Aim for a blood sugar level of around 180 mg/dL before surgery, and try to schedule your procedure for the morning to minimize fasting time and its impact on your blood sugar levels.

  • Pre-Operative Blood Glucose Checks: Blood glucose levels should be checked in the preoperative area before any surgery. If you are hyperglycemic or hypoglycemic, treatment should be provided before the operation. For hypoglycemia, glucose tablets, gels, or intravenous dextrose solutions may be used. If your blood glucose levels are severely high (over 250 mg/dL) or you are experiencing metabolic decompensation (like diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome), your surgery may need to be postponed until your blood sugar is better controlled.

Final Thoughts

Managing Type 1 diabetes during surgery requires careful planning and communication with your healthcare team. By following these guidelines and working closely with your doctors, you can help ensure a smoother surgical experience and a quicker recovery. Always remember to consult your healthcare provider for personalized advice tailored to your specific health needs.

Call to Action:

Still have questions about managing blood sugar prior to surgery? Wondering what this means for you as an individual? We’re here to help! Contact us for personalized, one-on-one support today.

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