Children with Diabetes having surgery

Information for parents and carers

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Children with Diabetes having surgery – PIAG 127 (224kB pdf)

Diabetes management advice before your child’s procedure

On the day and night before the procedure your child can continue
their usual insulin dosing. Check all equipment is working. If your child
uses an insulin pump then change to a fresh giving set and cannula.

If your child takes Metformin oral medication this must be stopped
24 hours before the procedure

On the day of the procedure

Eating & Drinking

• Your child must not eat for at least 6 hours before the procedure
  (last meal at midnight for a morning procedure, or 6:30am for an
  afternoon procedure).
• Your child may drink clear fluids (eg water, diluted cordial) up to
  1 hour before the procedure

What to bring

Remember your child’s usual diabetes equipment (blood glucose and ketone monitors and their insulin and pens / pump).

• Bring dextrose tablets and apple juice in case of a hypoglycaemia (low blood glucose <4mmol/L).

Checking Blood Glucose

Check blood glucose every 2 hours and aim for a blood glucose
level of 5-11mmol/L.

Treating low glucose- under 4 mmol/L

If your child has low blood glucose whilst just on clear fluids,
treat with 4 dextrose tablets or 200ml apple juice.

• Only use other low blood glucose treatments such as Lucozade,
  sweets or glucogel if dextrose tablets and apple juice are not
  immediately available. Make a note of the time that these
  treatments are given, as in some cases the procedure may need
  to be delayed or cancelled.
• Always re-check blood glucose levels 15 minutes after treatment.
  If it is 5.5mmol/L or less, repeat the hypoglycaemia treatment

On the day of the procedure

If your child takes Metformin or another oral medication to treat diabetes, do not give it on the day of surgery.

Insulin treatment: Your child’s insulin doses on the day of the procedure will depend on the type of diabetes management. Your local diabetes team may offer specific advice, otherwise a general guide is below:

Children who use an insulin pump

• Continue your child’s basal rate and adjust as needed to maintain a blood glucose of 5-11mmol/L.
• If your child’s procedure is in the morning, do not give breakfast, or the breakfast bolus of insulin.
• If your child’s procedure is in the afternoon, give a very early light breakfast with the insulin bolus

Children on multiple daily injections

• Long acting insulin (eg Levemir, Lantus, Tresiba)
• if your child usually takes long acting insulin in the morning, then give 50% (half) of your child’s usual dose.
• Rapid acting insulin (eg Novorapid, Apidra, Humalog)
• If your child’s procedure is in the morning, do not give breakfast, or the breakfast injection of insulin.
• If your child’s procedure is in the afternoon, give a very early light breakfast with 50% (half) of their usual dose of insulin. Do not give breakfast, or the breakfast bolus of insulin

Children on twice daily regimen (eg Novomix 30, Mixtard 30)

• If your child’s procedure is in the morning, do not give breakfast
  or the breakfast injection of insulin.
• If your child’s procedure is in the afternoon speak to your
  diabetes nurse, or phone 0151 252 5766, to discuss the best
  dose to take in the morning

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.

This information can be made available in other languages and formats if requested.

PIAG: 127