The lack of evidence-based guidelines or nationally recognized protocols for the preoperative management of adult diabetics in the outpatient setting poses a challenge for the perianesthesia practitioner. The West Virginia University Hospital Perioperative Research Committee sought to develop an institutional protocol for management of this population. A retrospective chart review of diabetic outpatients who arrived the morning of surgery with elevated glucose levels was performed. The purpose of the chart review was to delineate indicators measured in the preoperative visit that could be predictive of patients arriving the morning of surgery with an elevated glucose level. Self-reported home fingerstick glucose values >200mg/dL were a statistically significant (p = .007) indicator of elevated arrival glucose in the preoperative holding area. Results of the chart review and best clinical evidence, as well as expert opinion, were used to develop an Adult Preoperative Diabetes Protocol and an accompanying Patient Instruction Tool.