Prise en charge d'un patient diabétique devant subir une intervention en urgence

Preoperative management of diabetic patients consists in the assessment of blood glucose and comorbidities (cardiac, renal, dysautonomia). Metformine must be stopped before surgery. Never interrupt basal treatment with insulin. Fasting period should be shortest as possible. Per and postoperatively the goal is to maintain blood glucose between 5 and 10 mmol/L. Ultra rapid short duration acting intravenous insulin should be favoured peroperatively while maintaining glucose infusion. Blood glucose should be measure every 1-2 hours and potassium level every 4 hours. Prevention of vomiting is critical. Postoperatively, intravenous insulin should be maintained to achieve blood glucose < 10 mmol/L, up to oral feeding with a relay by subcutaneous administration.