How is type 1 diabetes mellitus (DM) managed during surgical procedures?

Updated: Oct 08, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Surgical procedures—including the preoperative emotional stress and the effects of general anesthesia as well as the trauma of the procedure itself—can markedly increase plasma glucose levels and induce DKA in patients with type 1 DM. (See Perioperative Management of the Diabetic Patient.) In patients going to surgery who have not received a dose of intermediate-acting insulin that day, injection of one third to one half of the total daily dose as NPH insulin or 80% of the dose as glargine or detemir insulin before surgery is often effective.

At the same time, an IV infusion containing 5% glucose in either 0.9% saline solution or water should be started at a rate of 1 L (50 g glucose) over 6-8 hours (or 125-150 mL/h). Blood glucose levels should be checked every 2 hours during the surgical procedure, and small doses of regular or rapid-acting insulin (eg, lispro, aspart, or glulisine) should be given if values exceed 140 mg/dL.

After the operation, check plasma glucose levels and assess for a reaction to ketones. Unless a change in dosage is indicated, repeat the preoperative dose of insulin when the patient recovers from the anesthesia, and continue the glucose infusion.

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