Management of insulin treated diabetes during surgery

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The chief principle of diabetic management through any crisis in which patients cannot eat or drink for any reason is to continue insulin administration. The best method is to give the insulin by continuous intravenous infusion either by infusion pump or directly from the drip bag.

For operations in which a patient is likely to be maintained on a drip for more than 12 hours a regimen is needed which can be continued for an indefinite period. Again there are two methods of administering the insulin: a variable rate infusion using a pump, or if this is not available, a glucose insulin-infusion. Note:

• The rate of intravenous infusion must depend on the clinical state of the patient with regard to the volume depletion, cardiac failure, age, etc.

• Potassium replacement is required.

• If the blood glucose is persistently above 10mmol/l the infusion should be changed to 0-9% saline.

• Blood glucose should be monitored every one to two hours during surgery and regularly postoperatively.

• Try to maintain the blood glucose concentration in a safe range—6-0-12 mmol/l.

• Regular (at least daily) electrolyte measurements are required.

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