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- Preoperative:
 
 
- labs:
 
 
 
 
 
 
- HA1c
 
 
 
 
 
 
- UA: r/o ketones
 
 
 
 
 
 
- Osmolarity
 
 
- patients on oral hypoglycemics, d/c 1 day preoperatively;
 
 
- place on sliding scale;
 
 
- schedule AM operation if possible;
 
 
- start IV D5 1/2 NS: 75-100 cc/hr (D5W at 100 cc/hr only gives 400 kcal over 24 hrs);
 
 
- AM of surgery: 1/2 of usual SC NPH and Regular insulin dose
 
 
 
 
 
 
- in type I diabetics consider additional 1/4 Reg. insulin dose q 6hr
 
 
- brittle diabetic: consider continuous preoperative insulin iv infusion
 
 
- preop insulin management:
 
 
 
 
 
 
- 1 unit of insulin disposes of about 8 gm of glucose;
 
 
 
 
 
 
- 1 unit of glucose should decrease blood glucose by about 50;
 
 
 
 
 
 
- most operative patients can be maintained in the 120 to 180 blood glucose
 
 
 
 
 
 
 
 
 
range w/ regular insulin infusion rate set at 1.0 unit/hour and 2.0 U/hour;
 
 
 
 
 
 
- note: make the distinction between IDDM and NIDDM
 
 
 
 
 
 
 
 
 
- IDDM: pt must receive insulin on a routine schedule and must not be
 
 
 
 
 
 
 
 
 
 
 
 
 
be placed solely on a Sliding Scale;
 
 
 
 
 
 
 
 
 
- NIDDM: pt may be placed solely on Sliding Scale;

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- Postoperative:
- Continue IV Dextrose
- Provide 1/2 usual NPH Insulin (AM and PM)
- Check glucose q4-6 hr; adjust with Sliding Scale;
- adjust insulin dose with resumption of oral diet or enteral feeding.
- resume Antidiabetic agents
- UA: r/o ketones
- IDDM: