Clinical recommendations in the management of the patient with type 1 diabetes on insulin pump therapy in the perioperative period: a primer for the anaesthetist

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Presentation transcript:

Clinical recommendations in the management of the patient with type 1 diabetes on insulin pump therapy in the perioperative period: a primer for the anaesthetist H. Partridge, B. Perkins, S. Mathieu, A. Nicholls, K. Adeniji British Journal of Anaesthesia Volume 116, Issue 1, Pages 18-26 (January 2016) DOI: 10.1093/bja/aev347 Copyright © 2016 The Author(s) Terms and Conditions

Fig. 1 Examples of Insulin pump systems. (a) A traditional insulin pump with tubing attached directly to the infusion site cannula. (b) A ‘patch pump’ with a self-contained insulin cartridge in the adhesive pod worn attached to the skin with an integrated subcutaneous cannula and a hand held blue-tooth control device (http://www.designbuzz.com/omnipod-insulin-management-system-living-easier-diabetes/). British Journal of Anaesthesia 2016 116, 18-26DOI: (10.1093/bja/aev347) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 2 How to perform a basal assessment. An example of a basal assessment trace. The 4 h post prandial blood glucose should vary by less than 1.7 mmol litre−1 throughout the test, if the basal profile is correct. Any significant deviation from this or hypoglycaemia should prompt a consultation with the diabetes team BEFORE surgery is scheduled. Ideally the basal assessment should be conducted and repeated at least once after any adjustment to confirm accuracy. British Journal of Anaesthesia 2016 116, 18-26DOI: (10.1093/bja/aev347) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 3 Continuous glucose monitor (CGM) download. Each colour in the above diagram represents a different day of wearing the CGM system. The basal profile is very flat from about midnight through till 10 am when breakfast is introduced and the effect of carbohydrate on blood glucose control becomes evident. This patient was fasted from late evening and the effect of the carbohydrate from the evening meal no longer has an effect from about 11.30 pm. This is an example of what can be achieved with a personalized basal rate. British Journal of Anaesthesia 2016 116, 18-26DOI: (10.1093/bja/aev347) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 4 What to do if the pump needs to be removed during a hospital admission? British Journal of Anaesthesia 2016 116, 18-26DOI: (10.1093/bja/aev347) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 5 ‘Sick Day Rules’ algorithm for managing high blood sugar on CSII. British Journal of Anaesthesia 2016 116, 18-26DOI: (10.1093/bja/aev347) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 6 Managing CSII Patients throughout Surgery (All discussions and a proposed plan should be clearly documented). British Journal of Anaesthesia 2016 116, 18-26DOI: (10.1093/bja/aev347) Copyright © 2016 The Author(s) Terms and Conditions