Admit the patient 24 to 48 hours
preoperatively to optimize insulin therapy and try to keep the blood glucose
levels slightly higher (i.e., 5-12 mmol/liter) than generally accepted for
older children. These patients should be booked at the beginning of the
operating list. Different treatment options are available for the management of
IDDM. We recommend the treatment you commonly use and with which you are
familiar. One regimen consists of omitting the morning dose of insulin,
starting an intravenous glucose-insulin infusion (either separately or
mixed), and adding potassium as required. Preoperative laboratory
investigations should include a 24-hour serum glucose profile, glycosylated
hemoglobin or fructosamine, fasting blood glucose level, complete blood
count, and serum concentrations of electrolytes, creatinine, and urea.
Limited joint mobility may affect the head and neck, and the “prayer sign”
(attempt to press the two palms as flat as possible against each other
without leaving a gap in between) can be helpful in determining the degree
of joint involvement, which can be important for the anticipation of difficult
airway management.