Sabiston textbook of surgery 21th edition
In general, long-acting insulin (glargine or detemir) should be administered as scheduled during the perioperative period. Intermediate-acting insulin (NPH, zinc insulin, extended zinc insulin) should be administered at one half dose on the morning of surgery and resumed at normal dose once a normal diet has been resumed. Short-acting insulins (regular, lispro, glulisine, aspart, and proportional combinations of intermediatewith short-acting insulins such as 70/30 or 50/50) are generally held and not administered during the morning of surgery. Insulin pumps should be set to the basal infusion rate and reprogrammed to regular settings once a normal diet has been established. Inpatient endocrinology consultation is frequently helpful in the management of patients with complex insulin regimens or poor glycemic control.
Perioperative management of oral hypoglycemics also has evolved. In general, sulfonylureas (e.g., glyburide, glipizide, glimepiride, and other single-agent or combination sulfonylureas) are withheld the day of surgery. DPP-4 inhibitors (gliptins) typically are administered the morning of surgery. Administration of metformin the morning of surgery is controversial. Historical data suggested an increased risk of lactic acidosis among patients on metformin; thus, liberal withholding parameters were used. More recent data, including a Cochrane systematic review, do not corroborate this increased risk; instead, they note a number of potential benefits of continuing metformin the day of surgery including improved perioperative glucose control.
口腔外科小手术操作指南， 2nd edition