Your Insulin Regimen Day of Surgery

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These guidelines assist patients with diabetes in dosing their insulin on the day of and day after surgery. Care providers give it to patients during diabetes planned visits, and it is included in the Diabetes Planned Visit Notebook.

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Your Insulin Regimen Day of Surgery

Family Medicine Center of Akron

Time	Blood Glucose	Insulin
Breakfast		Humalog 75/25
	0-60	Call
	61-99	Half of usual intermediate insulin 26 units
	100-149
	150-199	Two thirds of usual intermediate insulin 36 units
	200-249
	250-299	Three quarters of usual intermediate insulin 40 units
	300-349
	350-399
	400 or more	Call physician
After Surgery
		Humalog 75/25
	0-60	Call
	61-99	32 units
	100-149
	150-199	42 units
	200-249
	250-299	48 units
	300-349
	350-399
	400 or more	Call physician

Take your glucose monitor, glucose tablets and glucagon with you.

Check your sugar before surgery.

If it is under 80 before surgery, discuss with the anesthesiologist or nurse and ask if you may take some glucose tablet, or if they can give you some extra glucose by vein.

Check your sugar right after surgery, and every 2 hours until it is under 200.

1. IV fluid before and during surgery
   - D5W 1/2NS + 20mEq KCl @100cc/hr.
2. Check blood sugar hourly during surgery.
3. Ideal blood sugar is between 100 to 200.
4. Surgeon or anesthesiologist may want to control blood sugar with an insulin drip during surgery.
   1. Separate line for glucose and insulin.
   2. Regular Insulin 100 units in 100 cc NS (1 unit per 1 ml).
   3. Begin insulin infusion @ 1 unit/hr.

Intra-operative Insulin Drip

1. Goal MBS 100-200
2. Separate line for glucose and insulin
3. Regular Insulin 100 units in 100 cc NS (1 unit per 1 ml)
4. Begin insulin infusion @ 1 unit/hr

Suggested adjustments

Glucose <70 Then:

• Give 25 ml of D50 IV (or 10-12 grams glucose).
• Turn off Insulin drip for 30 minutes.
• Recheck Blood Glucose every 30 minutes till over 100 mg/dl.
• Blood Glucose on recheck still <70.
• Give 25 ml of D50 IV (or 10-12 grams glucose).
• Restart infusion when glucose >100 mg/dl.

Glucose 71-100 Then:
Decrease Insulin drip by 0.5 units/hour

Glucose 100-200 Then:
No change

Glucose 200-300 Then:
Increase Insulin drip by 2 units/hour

Glucose 301-350 Then:
Increase Insulin drip by 3 units/hour

Glucose 351-400 Then:
Increase Insulin drip by 4 units/hour

Glucose >400 Then:
Increase Insulin drip by 5 units/hour

Questions about your insulin on the day of surgery? Please call the Family Medicine Center at (330) 375-3584 or 1-800-460-2332.

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