Dextrose drip and variable rate insulin infusion

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(1) Give normal insulin on the night before the operation

(2) Early on the day of operation start an infusion of 10% dextrose, add 20mmol potassium chloride to each litre, and run at a constant rate appropriate to the patient's fluid requirement, usually 100ml/h

(3) Make up a solution of soluble insulin 1 unit/ml saline in a syringe and infuse intravenously by a line piggybacked to the intravenous drip by using a syringe pump. The infusion rate should normally be as shown in regimen 1, but in resistant cases use regimen 2 or 3

Blood glucose

Soluble insulin infusion rate

Regimen 1

Regimen 2

Regimen 3

< 4 mmol/l

0-5unit/h

1 unit/h

2 unit/h

4-10 mmol/l

2unit/h

4unit/h

8 unit/h

10-15 mmol/l

4unit/h

8 unit/h

16 unit/h

15-20 mmol/l

6 unit/h

12 unit/h

24 unit/h

> 20 mmol/l

Review

Blood glucose is measured preoperatively and then two hourly until stable, then six hourly

Regimen 1 is satisfactory for most cases; very severely ill patients, shocked patients, and those receiving steroids, salbutamol, or dopexamine infusions may need higher dose infusions, such as regimens 2 or 3, occasionally even more.

Do not stop the insulin infusion since intravenous insulin lasts for only a few minutes

Only if the patient becomes frankly hypoglycaemic (blood glucose < 2-0 mmol/l) should insulin be stopped for up to 30 minutes

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