Ch.15:Management of children & adolescents with diabetes requiring surgery
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2/8/2018 at 7:36:37 PM GMT
Posts: 34
Ch.15:Management of children & adolescents with diabetes requiring surgery

Dear ISPAD member/friend,

Thank you for your continued interest in the 2018 ISPAD Clinical Practice Consensus Guidelines and in the previous drafts chapters we shared with you.

We are happy to announce that Chapter 15 on the Management of children and adolescents with diabetes requiring surgery is now ready for you to read and comment on. We look forward to hearing your thoughts and input on this chapter.

Kind regards,

David Maahs

ISPAD Secretary-General



Last edited Tuesday, April 24, 2018
2/10/2018 at 4:36:13 PM GMT
Posts: 9

Dear authors, I have several comments and suggestions for your consideration.

 

P.3 Increasing use of glucose monitoring

 

P.4 … scheduled as the first case of the day on the surgical list

… insulin regimen

 

P.8 Type 2 diabetes “Patients undergoing a major surgical procedure expected to last at least 2 hours should be monitored and started on an IV insulin infusion”

Provide more specific instructions about what should be monitored and how frequently.

 

P. 9 insertion of grommets

 

P.10 “… all surgery or investigations under anesthesia that are more than minor …”

Require BG monitoring before, hourly during, and after the procedure to detect hypo- and hyperglycemia”

 

P.12 “… despite use of a tight blood glucose control protocol”

 

Use of “diabetic” is not recommended; diabetic is repeatedly used throughout the manuscript. At least in the USA where I live and work, there is an ongoing campaign to raise awareness that people with diabetes do not want to be referred to as diabetics. 

“… poorly controlled individuals with diabetes”

 

“Since the adult literature shows that outcomes are affected by the state of patients with diabetes before undergoing surgery, these studies allow us to make the following recommendations: …”

 

There are currently sufficient data (plural) …

 

P.13 In the discussion about pediatric reports in the critical care setting, the authors should be explicit that these studies were performed in children who did not have diabetes.

 

P.15 does “electrical equipment” refer to electrcautery?

 

P.17 “Must be admitted to hospital if receiving general anesthesia” Does this recommendation refer to BEFORE the procedure?

In the US, many patients with well controlled diabetes who are scheduled for major procedures arrive in the pre-operative suite early in the AM on the day of the procedure. Health insurance does not pay for admission on the day before surgery in such cases.

If the patient has other reasons to be hospital or diabetes is not well controlled, then admission before surgery would be approved.

 

Insulin regimen

 

Make a recommendation about how frequently BG should be measured intra-operatively

 

Why reduce long-acting basal insulin by 50% or basal infusion rate by 20% if the dose has been properly calibrated?

 

Continue usual basal rate

 

P.19 Why 80% of the usual correction factor if BG >250 mg/dL?

Indicate a target BG to calculate the correction dose.

At my institution, we use 150 mg/dL as the correction target in the setting of surgery and anesthesia.

 

P19 What BOHB concentration defines “significant ketone production”?  see also P.20

 

“glucose status” – I suspect this means current BG concentration?

 

P.23 insulin regimen

 

P.25 Potassium

Here, the authors point out that it is potentially dangerous to add potassium to the IV fluids in case there is an urgent need for rapid fluid resuscitation.

For clarity, I suggest re-writing the sentence:

“Monitor electrolytes pre- and post-operatively.  Only after completion of surgery and when the patient’s vital signs are stable, consider adding potassium chloride 20 mmol/L of intravenous fluid”



6/11/2018 at 3:59:38 PM GMT
Posts: 34
We want to thank all members who provided feedback on the Management of children & adolescents with diabetes requiring surgery

These comments were used to update the chapter. 

Specific responses are provided in the attached PDF.

 Attached Files: 

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