PIG Meeting: 8th April 2021
63-year-old lady normal pressure hydrocephalus.
History of headaches and dizzy spells.
- 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
- 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
- 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
- Operating Surgeon eventually contacted – happy to defer until glycaemic control improved.
- Expediate endocrine and GP reviews