Anaesthesiology & Critical Care · Integrated Module

Glucose Metabolism
& Control

🧠 20 Cognitive Nodes
✋ 14 Skill Nodes
❤️ 7 Affective Nodes
⚡ Integration Score: 96%
Three-Domain Architecture
🧠 Cognitive Domain

Core Concepts

20 nodes · Mastery: In Progress
  • Normal glucose physiology and homeostasis
  • Stress response and stress hyperglycaemia
  • DKA pathophysiology and diagnosis
  • HHS pathophysiology and diagnosis
  • Hypoglycaemia pathophysiology and consequences
  • Perioperative hyperglycaemia: clinical consequences
  • Glucose control targets: NICE-SUGAR & 2024–2025 updates
  • Insulin pharmacology and infusion protocols
  • Oral & non-insulin medications — perioperative management
  • Glucose monitoring technologies — present & future
  • Special populations: paediatric, elderly, pregnancy, obesity, steroids, liver/renal failure
Mastery Progress~60%
✋ Psychomotor Domain

Core Skills

14 nodes · Proficiency: Developing
  • Preoperative diabetes assessment and optimization
  • Variable-Rate IV Insulin Infusion (VRIII) protocol
  • DKA management protocol
  • HHS management protocol
  • Hypoglycaemia detection and rescue protocol
  • Transition from IV to subcutaneous insulin
  • Perioperative glucose monitoring protocol
  • Steroid-induced hyperglycaemia management
  • Carbohydrate counting for insulin adjustment
  • Arterial/venous blood gas glucose measurement
  • Continuous glucose monitor (CGM) interpretation
  • Insulin pump management in perioperative period
Proficiency Progress~45%
❤️ Affective Domain

Attitude Dimensions

7 nodes · Maturity: Cultivating
  • Shared decision-making: balancing glycaemic control and hypoglycaemia risk
  • Team communication about glucose management (SBAR)
  • Speaking up about hypoglycaemia risk (CUS tool)
  • Patient education about perioperative diabetes management
  • Debriefing after diabetic emergencies
  • Ethical considerations in glycaemic management
  • Cultural competency in diabetes care
Maturity Progress~50%
Core Curriculum Integration

Based on 2024–2025 ADA/EASD guidelines, Joint British Diabetes Societies protocols, NICE/SIGN updates, and Surviving Sepsis Campaign recommendations.

Domain Key Principles Integration Points
Preoperative Optimization HbA1c threshold >8.5% — consider delay; medication reconciliation (SGLT2i hold 3–4 days) Pharmacology Assessment Shared Decision-Making
Intraoperative Management Target 140–180 mg/dL; VRIII for NBM patients; hourly monitoring NICE-SUGAR Insulin Titration Vigilance
DKA/HHS Emergencies Fluid resuscitation, insulin therapy, K⁺ replacement, treat precipitant Pathophysiology Protocol Execution Crisis Leadership
Hypoglycaemia Prevention Background glucose infusion for NBM; recognise high-risk patients Risk Factors Rescue Protocol Speaking Up
Knowledge–Skill–Attitude Flow
🧠 Cognitive Pathways
Stress Hyperglycaemia
↓
DKA vs HHS differentiation
NICE-SUGAR 2009 legacy
↓
Target 140–180 mg/dL
SGLT2i Mechanism
↓
Euglycaemic DKA risk
Insulin Pharmacology
↓
VRIII principles
✋ Psychomotor Pathways
Preop Assessment
↓
HbA1c & medication reconciliation
VRIII Setup: 50U/50mL
↓
Titration algorithm
DKA Protocol
↓
Fluids, insulin, K⁺, bicarbonate
Hypoglycaemia Rescue
↓
D50W, glucagon administration
❤️ Affective Pathways
Shared Decision-Making
↓
Target discussion with patient
Team Communication
↓
SBAR handover structure
Speaking Up
↓
CUS tool for hypoglycaemia risk
Debriefing
↓
Learning from emergencies