Surgery in the Diabetic Patient

A Glucose/Potassium/Insulin infusion is used in insulin-dependent diabetes and for major surgery in non-insulin-dependent diabetics. NIDDM having minor surgery DO NOT need insulin (Obviously these patients would only undergo surgery if their diabetes is under control)

Fast overnight. Operated on early in the morning, if possible.

• 1 hr pre-surgery start infusion*- containing 500ml 10% Dextrose, 10IU Actrapid, 10 mmol KCl

• infuse at 100 ml/hr.

• Check capillary sugars in 1 hr and 2 hr (then, provided sugars are stable between 5 and 14, if theater delayed, 4 hourly check will be adequate)

• Aim to keep readings between 5-14mmol/1

• If Glucose $>$ 14 mmol, change infusion above* to one containing 15 IU Actrapid

• If Glucose $<$ 5 mmol, change infusion above* to one containing 500 mls 5% Dextrose only. Infuse at 100 mls/hr.

NOTE:

Patient $>$ 90 kg should receive 15 IU Actrapid instead of 10 IU as initial infusion dose

Post surgery, keep above infusion and check capillary glucose 1 hr and 2 hr postop and then if sugars stable, 4 hourly.

As soon as the patient can eat, usual insulin or oral medication should be resumed. If patient is not eating adequately, reduce insulins (short and intermediate acting) by 4 units each or reduce diabetic tablets by 1/2.

Do not go from above regime to sliding scale, there is no need.

• Peak action of Actrapid is 1.5 - 2.5 hr. Duration of action up to 8 hrs
• Peak action of Insulatard is 8 hr. Duration of action up to 22 hrs
• Peak action of 30/70 Mixtard is 4 hr. Duration of action up to 20hrs