Whenever surgery is postponed until PM, in order to avoid dehydration commence 100 ml/hr of dextrose saline at 9 AM and give S/C Actrapid at 8-9 AM according to sliding scale. At 1 hour pre-theater the above regime should be followed.
In cardiac surgery with bypass, glucose requirements are low and insulin requirements high so glucose and insulin should be infused separately
In patients with renal failure, glucose and insulin should be infused
separately 100 ml of 10% glucose/hr (or 50 ml 20% glucose/hr if fluid overload a
problem) and insulin 2 IU/hr. (50 units of Actrapid diluted in 50 ml of Normal
Saline, giving solution of 1 unit/ml, ie 2 u/hr = 2 ml/hr) Monitor capillary
sugars hourly. K
addition to iv glucose should be decided individually.
6 hourly sliding scale can be used in parenteral nutrition and in chemotherapy
SLIDING SCALE
| Capillary glucose (mmol) | Units of Actrapid s/c |
 6 mmol |
0 IU |
| 6-10 mmol | 4 IU |
| 10-14 mmol | 6 IU |
| 14-16 mmol | 8 IU |
| 16-20 mmol | 10 IU |
 20 mmol |
12 IU |