Management du patient diabétique en ambulatoire

Diabetic patients can be managed in day-case surgery when blood glucose is properly controlled and when patients are compliant to the constraints of ambulatory practice. Insulin or sulphonylurea are given on the morning of surgery, in agreement with the usual schedule. Breakfast is briefly replaced by an intravenous carbohydrate intake, until next oral feeding. For type 2 diabetic patients, a “no glucose-no insulin” protocol may be used. Biguanides have to be stopped 24 hours before surgery. Scheduling surgery early in the morning permits to take a snack at lunchtime and allows the patient to be discharged home in the afternoon, after a last blood glucose control. Vomiting and hyperglycaemia are contraindication to discharge.