What is the most appropriate preoperative management for a patient with T2DM undergoing gastric surgery?

For a patient with type 2 diabetes mellitus (T2DM) undergoing gastric surgery, the most appropriate preoperative management involves ensuring optimal glycemic control while minimizing the risk of perioperative complications. Stopping oral hypoglycemics the previous night and starting intravenous (IV) insulin with glucose before surgery is optimal for several reasons.

First, oral hypoglycemic agents often have varying actions. Many, especially sulfonylureas, can persist in the system and potentially cause hypoglycemia during the perioperative period, particularly in a fasting state. By stopping these medications the night before surgery, the risk of hypoglycemia during the procedure is reduced.

Secondly, IV insulin provides a rapid and controllable way to manage blood glucose levels. Insulin allows for immediate adjustments depending on the patient’s blood glucose readings, making it easier to maintain glycemic control, which is crucial during surgery and recovery. The administration of glucose alongside IV insulin is also important to prevent hypoglycemia, especially since patients may be unable to eat or drink for extended periods due to the nature of the procedure.

In summary, the approach of stopping oral medications the night before and transitioning to IV insulin with glucose ensures a safer and more effective management of blood glucose during the surgical period