When pre-existing glycemic control is good and minor surgery only is planned, breakfast and oral agents are omitted on the morning of surgery (long-acting sulfonylureas should be omitted on the day prior to surgery). Dextrose infusions should be avoided and blood glucose checked every 2 hours. Postoperatively, oral agents may be recommenced at the time of the next meal. When glycemic control is poor or major surgery is planned, it is desirable to admit the patient before the day of operation to optimize blood glucose control with short- or intermediate-acting insulins. On the day of surgery, breakfast is omitted and the surgery covered with intravenous insulin and glucose (see later). Postoperatively, subcutaneous insulin is continued until blood glucose levels are stable when the patient can restart oral therapy.
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