PIG Meeting: 8th April 2021

63-year-old lady normal pressure hydrocephalus.

History of headaches and dizzy spells.

Background

• IDDM with suboptimal glycaemic control, HbA1C = 12%
• On 110 units of Ultra-long and rapid-acting insulin per day
• Previous endocrine reviews reveal poor glycaemic control over many years
• Compliant with medications but doesn’t have a glucometer
• No known diabetic complications but history difficult due to neurological symptoms
• COPD – NYHA 3 dyspnoea, current smoker
• DASI 4 METS

Issues

• Very keen for the procedure to proceed as symptoms limiting quality of life
• Difficult to ascertain reasons for poor glycaemic control
• Patient unaware of potential implications to health, particularly in the perioperative period
• Distance patient, postponement on the day of surgery would be a major inconvenience to the patient
• Unable to contact proceduralist, junior team members contacted and happy to continue

Discussion

• Endocrine and GP review organised but limited time
• Should we try and admit the patient the night before and commence an insulin infusion?
• Risk of no bed being available then procedure could be postponed
• Consensus that procedure is high risk for postoperative infection and should be postponed

Plan

• Operating Surgeon eventually contacted – happy to defer until glycaemic control improved.
• Expediate endocrine and GP reviews