Perioperative and/or Periprocedural Glucose Management
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Continuous intravenous insulin (CII) infusion is an optimal therapeutic strategy for perioperative glucose management.23 It may be started the night before a surgical procedure or on-call to the operating room. To allow time for titration to achieve the desired level of control, an insulin drip should be initiated at least 2 hours before surgery. In general, the IV insulin infusion rate is adjusted at 1 to 2 hourly intervals, based upon the fingerstick BG level, the current insulin infusion rate, and the rate of decrease in BG levels.
In general, when the patient will resume eating shortly following surgery (eg, cataract extraction) or a procedure (eg, cardiac catheterization or GI endoscopy), the diabetes medication regimen is continued as previously administered up to and through the night prior to surgery. If the patient takes evening NPH or glargine insulin, the usual dose is administered. The regimen is adjusted on the morning of surgery to reduce risk of hypoglycemia. In the patient who is taking oral antidiabetes agents, the morning dose on the day of the procedure is withheld. The morning dose of NPH insulin is generally reduced by one third to one half. Bolus insulin (aspart, lispro, or regular) is generally withheld unless the BG is over 180 mg/dL to 200 mg/dL, in which case a small dose is administered to blunt further rise in BG. The usual oral agent and/or insulin regimen is resumed when the patient begins to eat.
