Perioperative management of diabetes mellitus

Model answer

Assessment (4). Confirm type 1 (insulin-deficient), usual regimen, last insulin, ketones and blood gas to exclude DKA, volume status, electrolytes (K+), sepsis source (appendix).^[1]

Proceed vs delay (3). Emergency source control may proceed in parallel with metabolic treatment; pure elective work would wait for metabolic stability. If DKA present, start DKA pathway immediately; do not omit insulin.^[4]

Insulin strategy (4). VRIII with glucose substrate and potassium per protocol; never zero insulin in type 1; hourly glucose targeting a safe band (exam ~6–10 mmol/L).^[1][2]

Intraop priorities (4). Scheduled glucose checks (hypo is silent), avoid unthinking high-dose dexamethasone if already hyperglycaemic, maintain perfusion, plan postop VRIII-to-subcut overlap.^[1][5]