For a type 2 diabetes patient undergoing major surgery, what is the appropriate preoperative management regarding oral hypoglycaemics?

For a patient with type 2 diabetes undergoing major surgery, it is crucial to manage blood glucose levels carefully to minimize the risk of perioperative complications such as infection, delayed healing, and cardiovascular events. Stopping oral hypoglycaemics the night before surgery and starting an intravenous (IV) insulin sliding scale allows for better control of blood glucose during the perioperative period.

The rationale behind this approach includes the following key points:

1. Blood Glucose Control: Oral hypoglycaemics may not provide adequate control during the stress of surgery. The body's stress response during surgical procedures can lead to increased insulin resistance, making oral medications less effective.

2. Adjustability of Insulin: Using a sliding scale for IV insulin allows for real-time adjustments based on the patient's blood glucose levels. This flexibility is essential in a potentially unpredictable environment like surgery, where stress and changes in diet and activity can significantly affect glucose levels.

3. Minimizing Risks: By stopping oral medications, which can have prolonged effects and may lead to hypoglycemia, particularly in the fasting state prior to surgery, the risk of perioperative hypoglycemia is minimized. IV insulin provides a safer alternative that can be carefully managed.

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