Diabetes Planned Visit Notebook

36.2 Your Insulin Regimen Day of Surgery

These guidelines assist patients with diabetes in dosing their insulin on the day of and day after surgery. Care providers give it to patients during diabetes planned visits, and it is included in the Diabetes Planned Visit Notebook.

Your Insulin Regimen Day of Surgery

Family Medicine Center of Akron

Time Blood Glucose Insulin
Breakfast   Humulin N
  0-60 Call
  61-99

Half of usual intermediate insulin

Units

  100-149
  150-199 Two thirds of usual intermediate insulin
Units
  200-249
  250-299

Three quarters of usual intermediate insulin

Units

  300-349
  350-399
  400 or more Call physician
After Surgery
Check blood sugar every hour until under 200, then every 2 hours till bedtime
    Humalog*
  0-60  
  61-99  
  100-149  
  150-199 Units
  200-249 Units
  250-299 Units
  300-349 Units
  350-399 Units
  400 or more Call physician

*Calculate sliding scale by dividing 1800 by the usual total units of insulin.
Example: patient takes 80 units daily 1800/80 = 22.5 units
This means that ever unit of rapid acting insulin will decrease the blood sugar by about 22 points.

  1. IV fluid before and during surgery
    - D5W 1/2NS + 20mEq KCl @100cc/hr.
  2. Check blood sugar hourly during surgery.
  3. Ideal blood sugar is between 100 to 200.
  4. Surgeon or anesthesiologist may want to control blood sugar with an insulin drip during surgery.
    1. Separate line for glucose and insulin.
    2. Regular Insulin 100 units in 100 cc NS (1 unit per 1 ml).
    3. Begin insulin infusion @ 1 unit/hr.

Intra-operative Insulin Drip

  1. Goal MBS 100-200.
  2. Separate line for glucose and insulin.
  3. Regular Insulin 100 units in 100 cc NS (1 unit per 1 ml).
  4. Begin insulin infusion @ 1 unit/hr.

Suggested adjustments

Glucose <70 Then:

  • Give 25 ml of D50 IV (or 10-12 grams glucose).
  • Turn off Insulin drip for 30 minutes.
  • Recheck Blood Glucose every 30 minutes till over 100 mg/dl.
  • Blood Glucose on recheck still <70.
  • Give 25 ml of D50 IV (or 10-12 grams glucose).
  • Restart infusion when glucose >100 mg/dl.

Glucose 71-100 Then:
Decrease Insulin drip by 0.5 units/hour

Glucose 100-200 Then:
No change

Glucose 200-300 Then:
Increase Insulin drip by 2 units/hour

Glucose 301-350 Then:
Increase Insulin drip by 3 units/hour

Glucose 351-400 Then:
Increase Insulin drip by 4 units/hour

Glucose >400 Then:
Increase Insulin drip by 5 units/hour

Questions about your insulin on the day of surgery? Please call the Family Medicine Center at (330) 375-3584 or 1-800-460-2332.

Page last reviewed October 2014
Internet Citation: 36.2 Your Insulin Regimen Day of Surgery. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/diabnotebk/diabnotebk362.html