controlling blood sugar during surgery

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I am wondering how you control a diabetics blood sugar, monitoring and insulin, during surgery (longer surgeries I am guessing would be more of a concern). My med-surg book says that SC injections are given 30 mins before surgery, but I am not sure if insulin is normally given while the patient is under anesthesia. Would you just monitor blood sugar as usual, and give insulin as needed? (According to orders/sliding scale, etc...)

Any help is appreciated.

~J

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Depending on high that that thte patient's glucoses have been running and the length of the surgery, they can either have sugars checked every hour and be given insulin, or may even have an insulin drip running. Either way they will be getting insulin. If the case is only an hour or so, they may not be giving extra insulin.

Again, each situation is looked at on its own. But the standard is to give insulin if it warranted.

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Thank you suzanne,

I didn't realize they ran insulin on a drip for surgery...I also didn't realize they would check blood sugars that often, wow. I wonder why my book doesn't have a section on this for perioperative care, with diabetes being so prevalent...hmmm.

Again, thank you!

~J

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If you can keep the blood sugars under better control, then the patient will also have better healing times.

Even the Association for Critical Care Medicine is rewriting their old rules, they want blood sugars around the 100 mark, no longer will 130 be acceptable.

----------------------But what is actually done in the OR can vary from facility to facility, but checking a blold sugar every hour for a case that it longer, is how things should be done. The blood sugars are normally done by the CRNA or the MDA.

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Blood gasses also include glucose levels. These are run frequently on big cases like cardiac surgery. High pre-op and intra-op glucose levels increase post-op infection rates. Things are done differently in surgery and most med-surg textbooks do not cover them.

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Specializes in NICU.
Thank you suzanne,

I didn't realize they ran insulin on a drip for surgery...I also didn't realize they would check blood sugars that often, wow. I wonder why my book doesn't have a section on this for perioperative care, with diabetes being so prevalent...hmmm.

I think the reason is that the nurse isn't usually the one doing these glucose checks and giving the insulin. During surgery, I believe this would be the job of the anesthesiologist or nurse anesthetist.

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Specializes in Gerontological, cardiac, med-surg, peds.

In many facilities, medical and nursing personnel are following the Portland Protocol post surgery (to aid in wound healing). Patients who are not even diabetics are being placed on insulin drips, because the stress of surgery will increase serum glucose. Tight serum glucose control is essential for optimal wound healing without complications. This is an excellent link:

http://www.providence.org/resources/oregon/PDFs/Protocol80120.pdf

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Specializes in CCRN.

I have noticed in our Med/Surg book this info is covered in the critical care section. I was curious recently why a Type 2 client who was undergoing a heart cath ( must be off her glucophage 72 hours pre/post) with a blood glucose of 320+ prior to the procedure was not to be on a sliding scale insulin regime for the 72 hours post. I was told it was probably due to the isue of the outpatient and education issue. Intresting.

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Specializes in Cardiac/Telemetry.

Question:

Why wouldn't you give an NPH SQ insulin injection? Would that be dangerous to the pt or would it just not work? I understand that during the surgery, the pt has an IV and it could be infused that way, but I'm just wondering why they wouldn't give the longer lasting insulin.

Mave.

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Specializes in Gerontological, cardiac, med-surg, peds.
I have noticed in our Med/Surg book this info is covered in the critical care section. I was curious recently why a Type 2 client who was undergoing a heart cath ( must be off her glucophage 72 hours pre/post) with a blood glucose of 320+ prior to the procedure was not to be on a sliding scale insulin regime for the 72 hours post. I was told it was probably due to the isue of the outpatient and education issue. Intresting.

A blood glucose that high definitely will impede healing....

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Specializes in Gerontological, cardiac, med-surg, peds.
Question:

Why wouldn't you give an NPH SQ insulin injection? Would that be dangerous to the pt or would it just not work? I understand that during the surgery, the pt has an IV and it could be infused that way, but I'm just wondering why they wouldn't give the longer lasting insulin.

Mave.

Probably because in the perioperative period, "tighter" blood glucose control is desired, due to the stress effects of surgery ("Fight or Flight" on blood glucose). Regular insulin has a short half-life, peak, and relatively rapid onset. It is much easier to control/ monitor (and to reverse, if need be), than the longer acting NPH.

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Question:

Why wouldn't you give an NPH SQ insulin injection? Would that be dangerous to the pt or would it just not work? I understand that during the surgery, the pt has an IV and it could be infused that way, but I'm just wondering why they wouldn't give the longer lasting insulin.

Mave.

You never give a longer-acting insulin before a procedure if the patient is not eating. The effects last too long, it is much easier to control with a short acting insulin that you have better control of. You used to see 1/2 dose given of the NPH, but I haven't even been seeing that anymore. A tighter control of the sugar is much preferred.

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