The resident's electronic handbook ...
DIABETES
MELLITUS
General :
1 E Insulin is needed to metabolize 2 g Glucose.
50% cover from a glucose infusion is enough.
Pre-operative (Routine case with last meal evening prior to OP):
Evening dose and evening meal as usual.
On operating day:
- Empty stomach-BS
- 1/4 of daily dose as long-acting Insulin (preferably own one) SQ
- 1/4 of daily dose as Actrapid in 1000 ml Glc. 5%
- 2-hourly intra-operatively, determine Blood Sugar and using Scheme I,
give Actrapid as needed in infusion.
Re-Injection Scheme I :
BS < 10 mmol/l, no Actrapid
10 - 13 mmol/l, 4 E Actrapid SQ
13 - 16 mmol/l, 6 E Actrapid SQ
BS > 16 mmol/l, 8 E Actrapid SQ
Controls post-OP:
< 13 mmol/l, every 6 hours, control / inject
> 13 mmol/l, every 3 hours, control / inject
Postoperatively:
If too little food intake, continue with above-mentioned infusion.
If food taken orally, give insulin before a meal using Scheme I.
Evening of OP day (8 p.m./20.00 hours), give 1/4 of daily dose of
own Insulin SQ.
If dose not known, then follow
Re-Injection Scheme II :
BS < 8 mmol/l 4 E Actrapid SQ
8 - 12 mmol/l 8 E Actrapid SQ
12 - 16 mmol/l 10 E Actrapid SQ
BS> 16 mmol/l 12 E Actrapid SQ
Nights:
if BS > 16 mmol/l, every 4 hours control / re-inject.
Diabetes treatment in exceptional situations:
Perfusion scheme (discuss with senior doctor) : 50 E Actrapid in
100 ml NaCl.
Begin with : 4 E/h (8 ml/h)
< 6 mmol/l : reduce
> 10 mmol/l : increase until 10 E/h
In Obstetrics, after the removal of the placenta, drastically reduce the
insulin level !
Type II Diabetes without previous insulin treatment :
stop oral anti-diabetic drugs preoperatively, empty stomach and using
scheme I, re-inject peri- und post-OP.
Attention: frequently Hypoglycaemia. Therefore, possibly additional
5% Glucose mornings and ca. 11.00h, renewed BS.
Conversion : mmol/l x 18 = mg %
02/16/96 kaufmannm@ubaclu.unibas.ch
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