Management of Diabetic Patients for Thyroidectomy

Preoperative Assessment and Management

The patient's current status with well-controlled thyroid function and mild hyperglycemia indicates the need for careful management, with a target blood glucose range of 100-180 mg/dL (5.6-10.0 mmol/L) for the perioperative period, as recommended by the American Diabetes Association 1, 2, 4
Prolonged fasting periods, such as being last on the surgical list, increase the risk of glycemic fluctuations, highlighting the importance of intravenous insulin administration to maintain glycemic control 3, 4

The American College of Surgeons recommends continuing IV insulin administration with hourly blood glucose monitoring during surgery to maintain glycemic targets between 100-180 mg/dL (5.6-10.0 mmol/L) and reduce the risk of surgical complications 2, 4, 5
After surgery, transitioning from IV to subcutaneous insulin when the patient resumes oral feeding, with basal insulin doses calculated as approximately half of the total daily IV insulin dose, is a recommended approach by the American Diabetes Association 1, 5, 6

Regular monitoring of capillary blood glucose levels every 1-2 hours while the patient takes nothing by mouth, as recommended by the American Association of Clinical Endocrinologists, is crucial to prevent hypoglycemia and hyperglycemia 4, 5
The risk of stress hyperglycemia, which may require additional insulin during the perioperative period due to surgical stress, should be considered, as highlighted by the American College of Cardiology 4