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

TOOLS
Koh: Intraoperative and Postoperative Glycemic Management in Patients with Diabetes
Focused Issue

J Korean Diabetes 2011;12(3):150-153.

Published online: 22 January 2011

DOI: https://doi.org/10.4093/jkd.2011.12.3.150

Intraoperative and Postoperative Glycemic Management in Patients with Diabetes

Gwanpyo Koh

Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea

Copyright © 2011 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Intraoperative care, Postoperative care, Hyperglycemia, Diabetes mellitus

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.
crossref
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.
crossref
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.
crossref

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.

TOOLS
Similar articles