Journal List > J Korean Diabetes > v.12(3) > 1054783

Koh: Intraoperative and Postoperative Glycemic Management in Patients with Diabetes

Abstract

Unlike minor operations, major surgeries require strict glycemic control using intravenous insulin infusion in patients with diabetes. The postoperative transition to subcutaneous insulin, if needed, can begin several hours before discontinuing intravenous insulin, by reinitiation of basal insulin reinitiation. Basal-bolus insulin regimens are safer and more effective in hospitalized patients than supplemental-scale regular insulin.

REFERENCES

1. Markovitz LJ, Wiechmann RJ, Harris N, Hayden V, Cooper J, Johnson G, Harelstad R, Calkins L, Braithwaite SS. Description and evaluation of a glycemic management protocol for patients with diabetes undergoing heart surgery. Endocr Pract. 2002; 8:10–8.
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2. Goldberg PA, Siegel MD, Sherwin RS, Halickman JI, Lee M, Bailey VA, Lee SL, Dziura JD, Inzucchi SE. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care. 2004; 27:461–7.
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3. Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, Puig A, Mejia R. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007; 30:2181–6.
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Table 1.
Yale insulin infusion protocol
jkd-12-150t1.tif
Table 2.
Protocol for supplemental insulin to correct hyperglycemia
Blood glucose (mg/dL) Insulin sensitivea Usuala Insulin resistanta
141-180 2 4 6
181-220 4 6 8
221-260 6 8 10
261-300 8 10 12
301-350 10 12 14
351-400 12 14 16
66> 400 14 16 18

Adapted from Umpierrez et al. Diabetes Care 2007;30:2181-6 [3].

a Numbers indicate the number of supplemental units of rapid-acting or regular insulin per dose.

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