Surgery and hospital stays fact sheet

When you have diabetes, having surgery or a medical procedure requires you to do some planning and take more care than usual.

Things that may affect your blood glucose levels during a hospital stay include:

• fasting (not eating or drinking)
• new or changed medications, including anaesthesia
• changes in activity levels and eating patterns
• stress, anxiety or pain.

Managing your diabetes before, during and after a procedure or surgery can help prevent complications, such as infections and delayed wound healing.

Have a diabetes management review beforehand

Before you have any surgery or procedures that require fasting, make sure you visit your GP, endocrinologist or credentialled diabetes educator. Ask them to review your current diabetes management and discuss how the procedure or surgery may affect this.

Important questions to ask your diabetes health professionals

• Discuss how to best look after your diabetes before and after the procedure or surgery.
• If you are taking insulin or diabetes medication (tablets or other injectable medications), check what adjustments you might need to make before, during or after the procedure or surgery, especially if you need to fast.
• Ask if your medications need to be changed temporarily, especially if you are taking metformin (brand names Diabex, Diaformin, Glucophage, Metex, Formet) or SGLT2 inhibitors (brand names Forxiga, Jardiance).
• Discuss your sick-day management plan and ask about treatment for low blood glucose levels (hypoglycaemia, or hypo) if you are fasting or on fluids before your procedure or surgery.

Talk to your surgeon/medical team

Ask your GP for a list of any special instructions you might need to look after your diabetes before the procedure/ surgery. Tell everyone involved, such as the nurses, anaesthetist and surgeons:

• that you have diabetes and how it is managed
• about any other medical conditions you have
• about any other medications you are taking (including vitamins, herbal medicines and over-the counter preparations).

Ask to be first or high on the list for procedures or surgery so your diabetes routine is disrupted as little as possible. Provide the hospital staff with the contact details of your endocrinologist, GP and credentialled diabetes educator. Larger hospitals may have a diabetes team to help with your care.

If you need an interpreter, make arrangements in advance. An interpreter service is available at no cost in public hospitals.

Check your blood glucose levels regularly

Talk to your doctor about whether you need to check your blood glucose levels more often before your procedure or surgery. If so, keep a record of your blood glucose levels for at least two weeks beforehand and have your diabetes health professionals review these so you can discuss what your target levels should be. Looking after your diabetes will help the healing process and reduce any risk of infection.

The day before and day of your procedure

• If your doctor has asked you to monitor your blood glucose levels, keep them in the target range as much as possible. Check your blood glucose levels more often as recommended by your health professionals. This is particularly important if your procedure requires you to fast.
• Treat any hypos you have before your procedure or surgery, even if you are fasting. Your doctor may recommend treating hypo with apple juice or another clear fluid, as this is quickly absorbed. Tell the medical staff about your hypo and how it was treated. They will accordingly decide whether your procedure can go ahead as planned.
• Take all medication or an up-to-date list of medications, hypo treatment and blood glucose monitoring equipment with you.
• Check with the health professional performing your procedure or surgery about any driving restrictions. You may need a relative or friend to drive you home.

After your procedure/surgery

• You may be asked to take your medication with a light meal before you go home. Follow your doctor’s advice about the dose you need to take.
• Resume your diabetes medications or insulin as instructed by your GP or endocrinologist. You may be advised not to take metformin—or to take a lower dose for a couple of days.
• Once you are discharged, review your medications and insulin with your GP or endocrinologist, especially as your condition improves and your blood glucose levels settle.
• Your doctor may ask you to check your blood glucose levels more frequently after your procedure or surgery. There is a higher risk of a hypo following fasting, and a risk of high blood glucose levels due to anxiety, stress or pain.
• If you are sick or unwell or have any side effects from the procedure or surgery, seek advice from the hospital or day surgery. Follow your sick-day management plan and talk to your doctor or diabetes educator.

Always contact your endocrinologist, GP or credentialled diabetes educator if you are not sure what to do with your medications or insulin, or if you are concerned about managing your diabetes. You can also ask the health professional performing your procedure or surgery to discuss your medications with your diabetes team.

This fact sheet is intended as a guide only. It should not replace individual medical advice and if you have any concerns about your health or further questions, you should contact your health professional.

Version 2 November 2018. First published June 2016.