I.v. glucose and insulin therapy

An example protocol is shown - protocols are likely to vary between hospitals and the locally agreed protocol should be followed:

• discontinue previous diabetic therapy
• give 1 litre of 10% dextrose 12 hourly with a 20 mmol potassium supplement
• the administration of insulin by infusion pump should be regulated according to the blood glucose level and should aim to keep glucose concentrations between 5 and 10mM:
  
  
• Blood sugar concentration; insulin infusion rate
• 5 mM; 1U/hr
• 5-10 mM; 2 U/hr
• 10-20 mM; 3 U/hr
• > 20 mM; 4 U/hr
  
  
• blood glucose should be measured regularly (and the insulin infusion rate altered accordingly):
  
  
• When to measure blood glucose; Frequency of measurement
• Preoperatively; At least once
• Intraoperatively; Hourly
• Postoperatively; 3-4 hourly
  
  

Intravenous glucose control should be continued until the patient is eating again. Thereafter the normal diabetic regime may be recommenced.