🩸 Perioperative / Stress Glycaemic Management
Inpatient and perioperative glucose targets, pre-op antidiabetic adjustment, steroid-induced hyperglycaemia and insulin-infusion points, per ADA inpatient standards. Browser-side.
Insulin is the only recommended perioperative glucose-lowering agent.
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When to use
Bedside reference for glycaemic targets and how to adjust diabetes medications around surgery.
How it works
Critically ill 140–180 mg/dL; non-critical pre-meal < 140 / random < 180; avoid < 70. Hold metformin on surgery day; stop SGLT2 inhibitors 3–4 days pre-op.
Key points
- Insulin is the only recommended perioperative glucose-lowering agent.
- Reduce basal insulin to 75–80% and hold prandial insulin while NPO.
- Steroid hyperglycaemia is mainly post-prandial; match insulin to the steroid.
- Give basal insulin before stopping an infusion to prevent rebound.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| View | Glucose targets |
|---|
→Key pointInpatient/perioperative glucose targets
- Critically ill：140–180 mg/dL (7.8–10.0 mmol/L); 110–140 may be considered for selected patients (e.g. post-cardiac surgery)
- Non-critical：Pre-meal < 140, random < 180 mg/dL
- Perioperative：100–180 mg/dL (within 4 h post-op); start insulin if persistently ≥ 180
| View | Insulin infusion |
|---|
→Key pointIV insulin infusion
- Indication：Critically ill with glucose ≥ 180, DKA/HHS, post-cardiac surgery, etc.
- Method：IV insulin infusion + hourly glucose, titrated by institutional protocol
- Transition：Give basal subcutaneous insulin 1–2 h before stopping the infusion to prevent rebound hyperglycaemia
Frequently asked questions
- What is Perioperative / Stress Glycaemic Management?
- Inpatient and perioperative glucose targets, pre-op antidiabetic adjustment, steroid-induced hyperglycaemia and insulin-infusion points, per ADA inpatient standards. Browser-side.
- How is Perioperative / Stress Glycaemic Management calculated? What is the core formula?
- Critically ill 140–180 mg/dL; non-critical pre-meal < 140 / random < 180; avoid < 70. Hold metformin on surgery day; stop SGLT2 inhibitors 3–4 days pre-op.
- When is Perioperative / Stress Glycaemic Management used?
- Bedside reference for glycaemic targets and how to adjust diabetes medications around surgery.
- What are the key clinical points for Perioperative / Stress Glycaemic Management?
- Insulin is the only recommended perioperative glucose-lowering agent. Reduce basal insulin to 75–80% and hold prandial insulin while NPO. Steroid hyperglycaemia is mainly post-prandial; match insulin to the steroid. Give basal insulin before stopping an infusion to prevent rebound.
- What are the limits and cautions when using Perioperative / Stress Glycaemic Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Perioperative / Stress Glycaemic Management calculated in practice? Can you show a worked example?
- Inputs: View Glucose targets → Result: Key point Inpatient/perioperative glucose targets（Critically ill: 140–180 mg/dL (7.8–10.0 mmol/L); 110–140 may be considered for selected patients (e.g. post-cardiac surgery), Non-critical: Pre-meal < 140, random < 180 mg/dL, Perioperative: 100–180 mg/dL (within 4 h post-op); start insulin if persistently ≥ 180） Inputs: View Insulin infusion → Result: Key point IV insulin infusion（Indication: Critically ill with glucose ≥ 180, DKA/HHS, post-cardiac surgery, etc., Method: IV insulin infusion + hourly glucose, titrated by institutional protocol, Transition: Give basal subcutaneous insulin 1–2 h before stopping the infusion to prevent rebound hyperglycaemia）