Diabetes - Child on elective surgery morning list

• Ensure child is first on the list
• Inform recovery staff of child with diabetes is coming to theatre
• Inform Anaesthetist
• Child is admitted to Ward 15 prior to evening insulin dose
• Child is clerked and consented by the appropriate Surgical Team
• Insulin is prescribed by the Paediatric clinical team on call
• Normal or reduced evening dose is given depending on recent glycaemic control
• (Aim to run the blood glucose slightly higher than normal)
• Blood glucose near patient testing must be carried out prior to supper and again prior to fasting (around 2 a.m.)
• If the blood glucose is low (<7mmol/l) immediately prior to fasting, give snack, e.g. toast or cereal, plus appropriate treatment if the patient is hypoglycaemic (i.e. a glucose drink)
  SEE FLOW CHART OF MANAGEMENT OF CHILD BECOMING HYPOGLYCAEMIC ON WARD

WITHHOLD MORNING INSULIN UNTIL INSTRUCTIONS AS PER ‘ON RETURN TO WARD’

Blood glucose near patient testing must be done at 7 a.m.

IF Blood glucose >7mmol/l

• Inform paediatric clinical team
• No need for IV fluids UNLESS blood glucose then drops <7mmol/l

IF Blood glucose <7mmol/l

• Site cannula and commence IV fluids 5% Dextrose + 0.45% Saline
• If blood glucose <5mmol/l, use 10% Dextrose
• Aim to maintain blood glucose between 7-13mmol/l but do not worry if blood glucose rises above 13mmol/l. Seek advice from Diabetes Team but DO NOT decrease rate of Dextrose infusion (if running) without discussion with Paediatric clinical team on call.

BLOOD GLUCOSE MONITORING SHOULD TAKE PLACE IN THEATRE AND IN RECOVERY AREA HALF HOURLY – USE RECORD SHEET PROVIDED 

• Check blood glucose level
• Contact Paediatric clinical team on call regarding insulin prescription doses (May require increased dose Novorapid and decreased dose Lantus or Levemir)
• Administer insulin as prescribed
• Allow patient to eat and drink as tolerated, ensuring that the patient receives IV fluids (Dextrose/Saline) if unable to manage oral intake
• Appropriate care related to surgery
• If child requires wound checks, Surgical Team on discharge please fill in referral form for community nurses

Blood glucose recording chart PDF

HYPOGLYCAEMIA IS BLOOD GLUCOSE LESS THAN 4MMOL/L
Treating a mild to moderate “hypo”
(Patient conscious and able to swallow)

NOTE:

1. Children who are using an insulin pump DON’T require a snack once blood sugar >4mmol/l.
2. If you have treated for hypoglycaemia x3 continuously and blood glucose remains below 4mmol/l child will need IV dextrose bolus/ IV fluids.
3. Do not give a correction at next meal if this will be less than 2 hours since hypo. Recheck blood glucose in an hour.
4. If patient has their own specific management plan for treating a hypo or uses Glucotabs® or anything other than above please record below for nursing staff to follow in ward.
5. If not tolerating oral fluids, give IV 10% Glucose 2mls /kg bolus.