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General Orders for Surgical Diabetic Patients

- 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;

- 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

Original Text by Clifford R. Wheeless, III, MD.