Perioperative management in Type 2 Diabetes

Patients undergoing bowel preparation for colonoscopy have altered calorie intake and physical activity for the days leading up to the procedure. With bowel cleansing, achieving adequate body fluid balance may be difficult especially in patients on diuretics, patients with renal impairment, and the elderly. Some patients may be safer to be in hospital for their bowel preparations.

When such patients are at home during their preparation, their management pre and post-operatively are often the responsibilities of immediate family members and the general practitioner. Written instructions for patients and their family can assist.

The time between decision for surgery and surgery date should be used to:

  • Optimise glycaemic control
  • Screen for complications
  • Make adjustments to the medication regimen if necessary
  • Assess patient’s self-management capacity

Red Flags

  • HbA1c > 9.0% (particularly if glycaemic management is complex)
  • BGL is unstable with hypos and/or BGL > 15 mmol/L

Patients with Type 2 diabetes may be on a combination of different classes of anti‑diabetic agents and peri‑operative management can be complicated. For all procedures, if red flags are present, consider postponement of the procedure and referral for specialist opinion.