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🩸 Perioperative / Stress Glycaemic Management

UseBedside reference for glycaemic targets and how to adjust diabetes medications around surgery.

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SourceAmerican Diabetes Association. Standards of Care — Diabetes Care in the Hospital

Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders

This-shift next steps

After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.

Scene next step
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Related scores
Score + version; reference only — not a substitute for care · no HIS write

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Methodology · worked example, guidelines & full notes
Clinical takeaway

Insulin is the only recommended perioperative glucose-lowering agent.

When to use

Bedside reference for glycaemic targets and how to adjust diabetes medications around surgery.

How it works

Critically ill 140–180 mg/dL; non-critical pre-meal < 140 / random < 180; avoid < 70. Hold metformin on surgery day; stop SGLT2 inhibitors 3–4 days pre-op.

Key points

  • Insulin is the only recommended perioperative glucose-lowering agent.
  • Reduce basal insulin to 75–80% and hold prandial insulin while NPO.
  • Steroid hyperglycaemia is mainly post-prandial; match insulin to the steroid.
  • Give basal insulin before stopping an infusion to prevent rebound.

References

Worked calculation

The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.

ViewPre-op drug adjustment

→Key pointPre-op antidiabetic adjustment

  • Metformin：Hold on the day of surgery
  • SGLT2 inhibitors：Stop 3–4 days pre-op (DKA risk)
  • Other oral / non-insulin：Hold the morning of surgery
ViewGlucose targets

→Key pointInpatient/perioperative glucose targets

  • Critically ill：140–180 mg/dL (7.8–10.0 mmol/L); 110–140 may be considered for selected patients (e.g. post-cardiac surgery)
  • Non-critical：Pre-meal < 140, random < 180 mg/dL
  • Perioperative：100–180 mg/dL (within 4 h post-op); start insulin if persistently ≥ 180
Verification & sources · governance
FAQ

Frequently asked questions

What are the limits and cautions when using Perioperative / Stress Glycaemic Management?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
Does Perioperative / Stress Glycaemic Management upload patient data? Where is it calculated?
Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
How is Perioperative / Stress Glycaemic Management calculated in practice? Can you show a worked example?
Inputs: View Pre-op drug adjustment → Result: Key point Pre-op antidiabetic adjustment（Metformin: Hold on the day of surgery, SGLT2 inhibitors: Stop 3–4 days pre-op (DKA risk), Other oral / non-insulin: Hold the morning of surgery） Inputs: View Glucose targets → Result: Key point Inpatient/perioperative glucose targets（Critically ill: 140–180 mg/dL (7.8–10.0 mmol/L); 110–140 may be considered for selected patients (e.g. post-cardiac surgery), Non-critical: Pre-meal < 140, random < 180 mg/dL, Perioperative: 100–180 mg/dL (within 4 h post-op); start insulin if persistently ≥ 180）
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