Perioperative management of glucose abnormalities

Indications

• Type 1 or 2 diabetes mellitus

Options

• Continuous IV insulin infusion
• Long-acting insulin only
• Hold oral medications

Continuous IV insulin infusion

Indications

• Type 1 or 2 diabetes mellitus patients who are on insulin and are preparing for one of the following procedures:
  • Any cardiovascular surgery
  • Any major surgery lasting 2 or more hours
  • Peripartum care in obstetrics
  • Scleral-buckle ophthalmology surgery
  • Any unstable patients, even if not previously on insulin

Procedure

• Calculate total daily dose (TDD) of insulin
• Initial infusion rate = (1/2 TDD) / 24h = TDD / 48h
• Use sliding scale to target 8-12 mmol/L

Long-acting insulin only

Indications

• Can be used for patients with diabetes, on insulin, who are going for short procedures (e.g. less than 2 hours)

Management

• Give between half and two-thirds of the intermediate-acting insulin in the morning, with a sliding scale of rapid-acting