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Standardisation of the management of diabetes mellitus during surgery.
Children with diabetes mellitus that require surgical.
Healthcare professionals involved in the management of paediatric surgical patents.
Surgery is a physical stress characterised by catabolism, increased metabolic rate, increased protein and fat breakdown, negative nitrogen balance, starvation and glucose intolerance. The degree of stress will be related to factors such as operation length, type of procedure and the presence of complications such as infection. All of these metabolic effects are exaggerated with diabetes, particularly where there is a virtual absence of endogenous insulin. Marked catabolism results in fatty acid production, ketogenesis, hyperglycaemia and eventually leads to ketosis and ketoacidosis.
The aim of routine diabetes care during admission for surgical procedures is therefore to:
BG target 4-8 mmol/l (may aim for 6-12 mmol/l to help prevent low BG).
The following insulins are available within the UK. Please note that some insulins with similar names actually have very different durations of action, and are very different preparations.
- Novorapid | Insulin Aspart | ||
- Levemir | Insulin Detemir | ||
- Lantus | Insulin Glargine | ||
- Humalog | Insulin Lispro | ||
- Actrapid | Soluble insulin | ||
- Humulin S | Soluble insulin | ||
- Humulin I | Isophane insulin | ||
- Humulin M3 | Soluble Insulin | + Isophane insulin | |
- Novomix 30 | Soluble Insulin | + Isophane insulin | NB: This is not “Novorapid” |
- Humalog Mix 25 | Insulin Lispro | + Isophane insulin | NB: This is not “Humalog” |
While Novorapid & Levemir are available from Pharmacy, Humalog may substitute for Novorapid and Lantus for Levemir if routinely used by patient concerned. Change may be made due to allergy, and this should be checked if insulin to be prescribed differs from patient’s usual insulin type.
See information below if patient using an insulin pump (CSII).
MORNING LIST Patient must be first on theatre list. Ensure no allergy to Levemir.
AFTERNOON LIST Patient must be first on theatre list. Ensure no allergy to Levemir.
See information below if patient using an insulin pump (CSII).
IF EATING LUNCH
IF EATING EVENING MEAL
IF NOT YET EATING AND DRINKING
Call Diabetes Service (T: 80331 M-F: 0900-1700) &/or Anaesthetist if using Complex/Emergency Surgery Protocol
BLOOD GLUCOSE (mmol/l) |
INFUSE SOLUTION AT |
EQUIVALENT TO (Units/kg/hr) |
> 22 mmol/l | Weight (kg) x 0.1 ml/hr (= Units/hr) | 0.10 |
14 – 22 | Weight x 0.07 | 0.07 |
8 – 13.9 | Weight x 0.04 | 0.04 |
4 – 7.9 | Weight x 0.02 | 0.02 |
< 4 | Weight x 0.01 and INCREASE INFUSED DEXTROSE CONC. | 0.01 |
HOW TO MAKE UP NaCl 0.45% and DEXTROSE 10% + KCl 10 mmol/500 ml
HOW TO MAKE UP NaCl 0.9% and DEXTROSE 10% + KCl 10 mmol/500 ml
Calculate Insulin Total Daily Dose (TDD) by adding ALL insulin taken in a typical 24 hour period
https://www.diabetes-scotland.org/ggc/ and then select "Protocols" from the menu.
Last reviewed: 07 September 2016
Next review: 30 November 2021
Author(s): Ken Robertson & Iain Craigy