ABUHB - Diabetes Drug Management Plan

Diabetic Drugs Only (Non-VRII)

Complete the form below to create a customised diabetes drug management plan

This plan can then be printed out and given to the patient / uploaded to CWS

Generated filename is : "HospitalID - Patient Name - Diabetes-Plan"

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Diabetes Peri-Operative Management Plan
Please Use Drug Management Chart

Patient Name:

Patient ID:

Patient date of birth:

INSTRUCTIONS ON HOW TO MANAGE YOUR DIABETES MEDICATION

  • Your Admission Letter will tell you the time at which you must stop eating and drinking.
  • While you are not eating and drinking, we may need to change how and when you take your diabetes medication to make sure your blood glucose levels are well controlled
  • If you are booked to have your surgery in the afternoon please have a light breakfast to avoid a low blood glucose level (Hypoglycaemia)

Surgeon:

Surgery:

Plan made by:

Date plan made:

Helpful information about your Diabetes

Type of Diabetes

HbA1c

Result: mmols/mol

Date:

eGFR

Result: ml/min/1.73m2

Date:

Hypoglycaemia Aware

Able to safely manage medication as advised

Patient Name:

Patient ID:

Patient date of birth:

DAY BEFORE SURGERY

Lantus

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Toujeo

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Glargine

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Xultophy

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Detemir

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Humulin I

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Tresiba

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Insuman

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Basal. Insulatard

(Long acting insulin - taken in the evening)

Day Before Surgery

80% of Evening dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Take all your OTHER insulin and non-insulin diabetes medication as normal

Eat as normal to avoid a low blood glucose level (Hypoglycaemia)

Take all your insulin and non-insulin diabetes medication as normal

Eat as normal to avoid a low blood glucose level (Hypoglycaemia)

DAY OF SURGERY

DIABETES MEDICATION

DAY OF SURGERY

Novorapid

(Short acting insulin)

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Humulin S

(Short acting insulin)

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Insuman Rapid

(Short acting insulin)

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Humalog

(Short acting insulin)

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Actrapid

(Short acting insulin)

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Fiasp

(Short acting insulin)

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Novomix 30

(Pre-mixed insulin)

Morning Surgery

50% (half) of normal morning dose

(50% = Normal dose x 0.5)

Eat lunch at usual time after your surgery and IF on three doses daily, take lunchtime dose

50% is LESS than your normal dose of insulin

Afternoon Surgery

50% (half) of normal morning dose with LIGHT BREAKFAST

(50% = Normal dose x 0.5)

Do not take a lunchtime dose

Usual dose at usual time with a normal meal after your surgery

50% is LESS than your normal dose of insulin

Humalog Mix 25

(Pre-mixed insulin)

Morning Surgery

50% (half) of normal morning dose

(50% = Normal dose x 0.5)

Eat lunch at usual time after your surgery and IF on three doses daily, take lunchtime dose

50% is LESS than your normal dose of insulin

Afternoon Surgery

50% (half) of normal morning dose with LIGHT BREAKFAST

(50% = Normal dose x 0.5)

Do not take a lunchtime dose

Usual dose at usual time with a normal meal after your surgery

50% is LESS than your normal dose of insulin

Humalog Mix 50

(Pre-mixed insulin)

Morning Surgery

50% (half) of normal morning dose

(50% = Normal dose x 0.5)

Eat lunch at usual time after your surgery and IF on three doses daily, take lunchtime dose

50% is LESS than your normal dose of insulin

Afternoon Surgery

50% (half) of normal morning dose with LIGHT BREAKFAST

(50% = Normal dose x 0.5)

Do not take a lunchtime dose

Usual dose at usual time with a normal meal after your surgery

50% is LESS than your normal dose of insulin

Insuman Comb 25

(Pre-mixed insulin)

Morning Surgery

50% (half) of normal morning dose

(50% = Normal dose x 0.5)

Eat lunch at usual time after your surgery and IF on three doses daily, take lunchtime dose

50% is LESS than your normal dose of insulin

Afternoon Surgery

50% (half) of normal morning dose with LIGHT BREAKFAST

(50% = Normal dose x 0.5)

Do not take a lunchtime dose

Usual dose at usual time with a normal meal after your surgery

50% is LESS than your normal dose of insulin

Insuman Comb 50

(Pre-mixed insulin)

Morning Surgery

50% (half) of normal morning dose

(50% = Normal dose x 0.5)

Eat lunch at usual time after your surgery and IF on three doses daily, take lunchtime dose

50% is LESS than your normal dose of insulin

Afternoon Surgery

50% (half) of normal morning dose with LIGHT BREAKFAST

(50% = Normal dose x 0.5)

Do not take a lunchtime dose

Usual dose at usual time with a normal meal after your surgery

50% is LESS than your normal dose of insulin

Humulin M3

(Pre-mixed insulin)

Morning Surgery

50% (half) of normal morning dose

(50% = Normal dose x 0.5)

Eat lunch at usual time after your surgery and IF on three doses daily, take lunchtime dose

50% is LESS than your normal dose of insulin

Afternoon Surgery

50% (half) of normal morning dose with LIGHT BREAKFAST

(50% = Normal dose x 0.5)

Do not take a lunchtime dose

Usual dose at usual time with a normal meal after your surgery

50% is LESS than your normal dose of insulin

Lantus

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Toujeo

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Glargine

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Xultophy

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Detemir

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Humulin I

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Tresiba

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Insuman

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Basal. Insulatard

(Long acting insulin - taken in the morning)

Day Of Surgery

80% of Morning dose

(80% = Normal dose x 0.8)

Usual dose at usual time post op

80% is LESS than your normal dose of insulin

Alogliptin

Take as normal

Sitagliptin

Take as normal

Saxagliptin

Take as normal

Vildagliptin

Take as normal

Linagliptin

Take as normal

Pioglitazone

Take as normal

Exanitide

Take as normal

Liraglutide

Take as normal

Lixsenatide

Take as normal

Dulaglutide

Take as normal

Semaglutide

Take as normal

Metformin

Take as normal

DO NOT take lunchtime dose

Metformin

DO NOT take on day of surgery

(patient has eGFR < 60 ml/min/1.73m2)

Acarbose

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Repaglinide

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Nateglinide

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Dapagliflozin

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Empagliflozin

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Canagliflozin

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Ertugliflozin

Do not take while not eating

Usual dose at usual time with a normal meal after your surgery

Glibenclamide

DO NOT take on day of surgery

Gliclazide

DO NOT take on day of surgery

Glimepride

DO NOT take on day of surgery

Glipizide

DO NOT take on day of surgery

Tolbutamide

DO NOT take on day of surgery

INFORMATION LEAFLET FOR PATIENTS WITH DIABETES UNDERGOING AN ELECTIVE SURGICAL PROCEDURE

This letter should provide you with the details you need to look after your diabetes around the time of your surgery.

Patients with well controlled diabetes have less risk of complications occurring with their surgery. Any improvements to you blood glucose levels that can be made, however small, can make a big difference.

In the weeks before your operation please increase the number of times you monitor your blood glucose and closely follow a healthy eating plan by avoiding or reducing portions of sugary and processed foods, high in glucose and carbohydrate.

PLEASE READ THROUGH THIS LEAFLET CAREFULLY

What should I bring with me to hospital?

  • The diabetes medication you usually take for your diabetes in the original boxes
  • Glucose tablets or a sugary (non- diet) drink, this is needed to treat a low glucose level
  • The blood glucose testing equipment you usually use

How to treat low blood glucose levels / hypoglycaemia (HYPO) on the way to the hospital?

If you experience any of the following:

Sweating, Dizziness, Blurred vision or Shaking

You may be experiencing a low blood glucose level / hypoglycaemia (HYPO)

Please test your blood glucose if you are able to do so

If you have any of the feelings or if your blood glucose is less than 4 mmol/L take ONE of:

  • 4 glucose tablets
  • 150 mls of the sugary drink (this is the same as half a standard sized can of non-diet cola)
URGENT

Please tell the staff when you arrive if you have had to treat yourself for a low blood glucose / hypoglycaemia

What happens when I arrive at the hospital?

  • Your blood glucose will be checked on admission
  • Your blood glucose will be checked every hour until you are eating and drinking normally and back on the medication you usually take to manage your diabetes
  • If this does not happen or you feel unwell please request the nursing staff to check your blood glucose
  • Your surgery should only stop you eating for 6 hours after missing your first meal
  • You should only miss one meal

How to look after your diabetes after your surgery

Monitor your blood glucose level if you have the equipment to do so (4 times per day)

  • Your blood glucose level may be slightly higher than usual. This is NOT a concern if you are feeling well
  • If you are feeling unwell follow “Sick Day Rules: What should I do if I feel unwell at home?”

Sick Day Rules: What should I do if I feel unwell at home?

NEVER STOP your diabetes medication

Illness usually increases your body’s need for insulin

If you can:

  • TEST your blood glucose levels every 2-4 hours day and night until you recover
  • TEST your URINE ketones every time you go to the toilet or your BLOOD ketones every 2 hours

DRINK at least 100mls of water or sugar free fluid every hour. This means at least 2.5 litres of low or sugar free fluid a day during illness (approx. 5 pints)

REST and avoid strenuous exercise as this may increase your blood glucose levels during illness

EAT as normally as you can.

If you are having difficulty in eating normally try replace solid food with one of the following:

  • 400 mls milk
  • 200 mls carton fruit juice
  • 150-200 mls non diet fizzy drink
  • 1 scoop of ice cream

If you are concerned, follow “When should I get urgent help?”

When should I get urgent help?

IF YOU EXPERIENCE ANY OF THE FOLLOWING:

  • PERSISTENT diarrhoea and vomiting and/or high fever
  • UNABLE to keep down food or fluid for at least 4 hours
  • HIGH blood glucose levels and feeling unwell.
  • KETONES at ++ 2 or +++3 in your urine or Ketones in your Blood of 1.5 mmol/L or more

Office Hours: Contact the Doctor or Nurse who normally helps you look after your diabetes immediately

Out of Hours: Contact the local GP Out of Hours Service or local Accident and Emergency Department

Contact information if you need further support

The staff of the Diabetes Clinic or your own General Practitioner are there to help. Managing diabetes medication around surgery can be difficult, if in doubt please contact us

FURTHER HELP AND ADVICE IS AVAILABLE FROM

Royal Gwent Hospital Diabetes Team

Tel: 01633 234271

Nevill Hall Diabetes Team

Tel: 01873 732049

Ysbyty Ystrad Fawr

Tel: 01443 802231

Diabetes UK Careline

Tel: 0845 120 2960

Email: careline@diabetes.org.uk