Guidance for patients with Diabetes who are undergoing surgical procedure requiring a period of starvation (no more than one missed meal)

On the day of the operation/procedure

You should not drive to and from for your operation or procedure especially you are on insulin therapy.

Remember to bring with you:
• Your blood glucose testing equipment (if you usually monitor your sugars at home)
• The tablets or insulin injection pens that you usually take for your diabetes
• Glucose tablets, a carton of orange juice or a sugary drink or Lucozade
• If the District Nurse administers your insulin in the morning, please also bring your folder.

Remind the staff at surgical unit that you have diabetes on arrival.

You may require insulin/glucose drip during the procedure/operation.

If your operation is in the morning:
• Do not eat any food after midnight
• Drink clear fluids such as water, black tea of coffee or sugarfree squash if required up until 06.30am

If your operation is in the morning:
• Do not eat any food after midnight
• Drink clear fluids such as water, black tea of coffee or sugarfree squash if required up until 06.30am

If your operation is in the afternoon
• Eat light breakfast before 06.30am and take no food after this time
• Drink clear fluids such as water, black tea of coffee or sugarfree squash if required up until 10.00am

After your operation

• You will be offered food and drink when you feel able to eat.
• You should resume your usual treatments for diabetes as advised in the information leaflet once you are eating and drinking.
• Monitor your blood glucose if you have the equipment to do so– 4 times per day if possible.
• Be aware that your sugar levels may be higher than usual for the first day or two after surgery. This is not a concern if you are feeling well.
• You should test more frequently if you are unwell.
• If you feel unwell after returning home please follow the advice for SICK DAY RULES.
• If you are unwell with vomiting, unable to take food or medication, contact your practice nurse or diabetes specialist nurse or attend accident and emergency department.
• If you have to stay in hospital after the procedure/operation, your diabetes and diet management will be looked after by the doctors and staff on the ward.

What to do if you are unwell

• NEVER stop taking your insulin or tablet(s) – illness usually increases your body’s need for insulin.
• TEST your blood sugars every 2 hours, day and night.
• TEST your urine for KETONES every time you go to the toilet or test your blood ketones every 2 hours if you have a suitable meter.
• DRINK at least a cup (100ml) of water/sugar free fluid every hour – aim to drink about 5 pints (2.5litres) per 24 hours.
• REST and avoid strenuous exercise since this may decrease your blood sugars during exercise.

• EAT normally if you can. If you have a smaller appetite than usual replace a meal with:
– 400ml milk or 200ml carton fruit juice or
– 200 ml non-diet fizzy drink or 1 scoop ice cream.

• CONTINUOUS vomiting and/or diarrhoea and/or a high fever
• UNABLE to keep food down for 4 hours or more and feeling unwell
• HIGH blood glucose levels (over 12mmol/L) with symptoms of illness – you may need more insulin
• KETONES at 2++ or 3++ in your urine or more than 1.5mmol/L in your blood – you may need more insulin.

If you are concerned please:
CONTACT the person or the clinical service that normally helps you look after your diabetes
OUTSIDE NORMAL WORKING HOURS Attend your local hospital Emergency Department.

• If you have symptoms of a low blood sugar such as sweating, shaking, dizziness, poor concentration or blurred vision please test your blood sugar if able to do so.
• If it is less than 4mmol/L, take 5 glucose tablets or a 200ml carton of orange juice or lucozade, or ½ can of a sugary drink such as coca cola. Re-check your blood sugar 10-15 minutes after treating the hypo.
• If you have the symptoms but do not have blood glucose testing machine, take 4 glucose tablets or a 200ml carton of orange juice or lucozade, or ½ can of a sugary drink such as coca cola.
• Inform the staff at the hospital as soon as you arrive if you have had drinks to treat your hypo

Please write down the medications you take for your diabetes or bring your prescription when you come for pre-operative assessment. If you take insulin, please write down the dose/ time/ type of insulin you take or bring your diabetes record.

Please discuss the plan with staff nurse at pre-operative assessment clinic.

Please bring the instructions given at the pre-operative clinic which provides information on what you should do with your tablets or
injection treatment when you come for the operation/ procedure.

• Oral diabetes medication (glucose lowering tablets): Acarbose, Metformin, Pioglitazone DPP4 inhibitors: Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin, SGLT2 inhibitors: Canagliflozin (Invokana®), Dapagliflozin (Forxiga®), Empagliflozin (Jardiance®) Sulphuronylureas: Gliclazide, Glimepiride, Glipizide or Tolbutamide
• Long acting/intermediate acting insulin: Abasaglar, Humulin I, Hypurin porcine Isophane, Insulatard, Lantus, Levemir,Toujeo, Tresiba, Semglee
• Quick acting or meal time insulin: Actrapid, Admelog, Apidra, Fiasp, Humalog, Humulin S, Hypurin porcine neutral, Novorapid, Trurapi, Lyumjev
• Premixed insulin: Humalog mix 25 insulin, Humalog mix 50 insulin, Humulin M3 insulin, Hypurin porcine 30/70 mixed insulin, Novomix 30 insulin

• CSII (Continuous Subcutaneous Insulin Infusion)
• Other injectable treatment (GLP-1): Daily injections of GLP- 1 agonist therapy (e.g. liraglutide (Victoza) or lixisenatide(Lyxumia)). Weekly injections of GLP-1 agonist injections (e.g. Dulaglutide (Trulicity), Exenatide LAR (Bydureon), Semaglutide (Ozempic), Tirzepatide (Mounjaro)

If your diabetes medicine is not included in the list, please contact your Diabetes Specialist Nurse or your General Practitioner.

* If the procedure includes using contrast, or you are undergoing cardiopulmonary

bypass surgery you will be asked to omit metformin for 48 hours before and 48
hours after procedure or surgery.

** Your surgeon and/or anaesthetist will perform an individual risk assessment.
You may be asked to omit your GLP1 injection prior to surgery

I take the following tablets for diabetes (dose/ timing)
1)
2)
3)

I suffer from type 1 diabetes/type 2 diabetes/not known type of
diabetes. I take following insulin injections (dose/timing/frequency).
1)
2)
3)

Please learn how to take your insulin the day before/on the day and
after the operation using the table on the opposite sheet. Please
discuss this with your staff nurse at pre-operative assessment clinic.
If you are on continuous subcutaneous insulin infusion (insulin pump),
continue usual basal rate of insulin infusion at usual dose and miss
bolus dose for missed meal pre and post procedure/surgery.
If the procedure/operation lasts less than two hours and it does
not include using diathermy and the pump is not interfering with
operative field, you could continue your pump on during the
procedure/operation unless you were advised differently by your
anaesthetist on the day.

Please bring your long acting insulin pen with you on the day. Please
discuss this with your staff nurse at pre-operative assessment clinic.

*If you require intravenous insulin infusion during the procedure, you will be guided by your doctor in hospital about your insulin doses
after the procedure.