36.4 Your Insulin Day of Surgery Mixed

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

TimeBlood GlucoseInsulin
Breakfast Humalog 75/25
 0-60Call
 61-99

Half of usual intermediate insulin

26 units

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

Three quarters of usual intermediate insulin

40 units

 300-349
 350-399
 400 or moreCall physician
After Surgery
  Humalog 75/25
 0-60Call
 61-9932 units
 100-149
 150-19942 units
 200-249
 250-29948 units
 300-349
 350-399
 400 or moreCall physician

Take your glucose monitor, glucose tablets and glucagon with you.

Check your sugar before surgery.

If it is under 80 before surgery, discuss with the anesthesiologist or nurse and ask if you may take some glucose tablet, or if they can give you some extra glucose by vein.

Check your sugar right after surgery, and every 2 hours until it is under 200.

  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.

Current as of January 2008
Internet Citation: 36.4 Your Insulin Day of Surgery Mixed. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/diabnotebk/diabnotebk364.html