ABUHB - Diabetes Drug Management Plan

VRII Only

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"

No data is saved / logged from this page.

Use the Toggle Data Entry button to Show/Hide the data entry menu (when ready to print)

Example data is pre-loaded for demonstration purposes. Just select your own drugs and hit Submit.

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Diabetes Peri-Operative Management Plan
Please Use Variable Rate Intravenous Insulin Infusion (VRIII) 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 need to change how we control your blood glucose levels using an insulin drip.
  • Please see box 'What happens when I arrive at hospital' for more information

Surgeon:

Surgery:

Plan made by:

Date plan made:

Helpful information about your Diabetes

This patient is on long-acting insulin. Please ensure this is continued at 80% of usual dose

Type of Diabetes

HbA1c

Result: mmols/mol

Date:

eGFR

Result: ml/min/1.73m2

Date:

Hypoglycaemia Aware

Able to safely manage medication as advised

Reason for VRII

Missing more than one meal:

HbA1c > 69mmols/mol:

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

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

Do NOT take any OTHER insulin and non-insulin diabetes medication

Do NOT take your diabetes medication while you are not eating

When can I return to my normal diabetes medication and stop the VRIII (insulin drip)?

The VRIII (insulin drip) will be stopped one hour after, you eat a normal meal with the normal dose of your diabetes medication

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 is likely to mean you will miss more than one meal
  • Once you have missed the first meal before your surgery we will need to give you a drip (IV) in your vein, this drip will contain a sugary fluid and insulin to keep your blood glucose at the right level
  • The drip is called a VRIII (Variable Rate Intravenous Insulin Infusion) you may know it as a Sliding Scale

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 73249049/p>

Ysbyty Ystrad Fawr

Tel: 01443 802231

Diabetes UK Careline

Tel: 0845 120 2960

Email: careline@diabetes.org.uk