Insulin Administration Pre-Surgery

[puppyrules]

I would like to know what the standard protocol is for the administration of insulin for diabetic patients before surgery. I have run into two schools of thought online. One is that the insulin should be regular (blood sugar should be monitored every 2-3 hours and insulin should be titrated accordingly). The other is that long acting insulin should be given instead. What is more common?

[truern]

I've had six surgeries in the past year and in each case I took my Lantus the night before and nothing the morning of..not even my metformin.

You'd rather it get a little high than to bottom out.

[nerdtonurse?, BSN, RN]

Ours is pretty much surgeon dependent. One wants like truern, one says give a half dose of R on sliding scale, one says it's better to give the insulin, they can always push d50 (!).

Me, it's simple. You don't eat, you don't get R or oral meds. I'd rather they not send me back someone who is bottoming out when they hit the floor...

[classicdame, MSN, EdD]

No point in offering long-acting if patient has never had it before. Long acting takes 2-3 days to be effective. We give long acting if patient is already taking it at home. We hold all others usually, but some procedures are longer than others and some require deeper sedation, etc. so the surgeon and the anesthesiologist or CRNA will have input on this. If they choose, we generally still hold the injections, but titrate regular IV.