Insulin and Surgery

Question 1

minor procedure with good glycaemic control

what should be done day before elective surgery?

Answer 1

reduce OD long-acting dose by 20% rest as usual

Question 2

major procedure or poor glycaemic control

what should be done day before elective surgery?

Answer 2

reduce OD long-acting dose by 20% rest as usual

Question 3

major procedure or poor glycaemic control

what should be done on the day of elective surgery?

Answer 3

-reduce OD long acting dose by 20% STOP other insulin till pt is able to eat
-IV infusion of KCL + glucose + Nacl
-variable rate IV insulin (soluble human) in NACL 0.9% via pump
-hourly blood glucose measurement for 1st 12hr
-give IV glucose 20% if blood glucose < 6mmol

Question 4

insulin post surgery

Answer 4

-change to SC when pt=eat/drink w/o vomiting
-basal-bolus regimen restarted with 1st meal - infusion carried till 30-60mins after 1st meal short acting glucose adminstration
-long acting regimen carries on at 20% reduced until leaves hosp
-BD regimen restart at breakfast or evening meal infusion carried on till 30-60mins after 1st meal

Question 5

sick day rules

Answer 5

-sugar levels = blood glucose check regularly
-insulin = continue on taking
-carbs = keep eating + hydrating
-ketones = check ketones regularly