Question

Ms. Warren is having gastric bypass surgery tomorrow She is a diabetic and injects 30 units of 70/30 insulin SQ in the evening before dinner and in the morning before her breakfast. What pre op instructions ( 24 hours before surgery ) should the Nurse Practitioner give her regarding her insulin dose and why?

Answer 1

Preoperative patients with diabetes need blood glucose level monitoring to maintain optimal glycemic control. there will be unique challenges for keeping glucose level with target range. persistent hyperglycemia leads to many complications like CVD, neuropathy, retinopathy, neuropathy, etc. careful glucose management strategies is important. educate the patient for glucose management by avoiding high glucose and low glucose level. maintain electrolyte and flid balance and establishing glycemic target level. advise patients to ensure that glucose level within normal ranges. monitor the glucose level before and after meals and before bed. finder stick glucose monitoring should be continued for every 4 to 6 hours when the patient is in NPO. explain the patient about supplemental insulin to correct hyperglycemia back to normal. long-acting insulin should be avoided for 3 days prior to surgery. advise patients to avoid oral glycemic control drugs. If patient take metformin should be stopped for 48hours before and after surgery to avoid complications like lactic acidosis. advice the patient about low carbohydrate diet with insulin dose for improvement in glucose control.