Diabetic Sliding Scale

¨ Blood sugar levels need regular assessment

¨ Sepsis increases the insulin requirements

¨ Patient has increased risk of post-op infection so cover with antibiotics

¨ GA patient put first on the list

¨ Will need drip put up 5% dextrose and syringe pump with insulin and sliding scale

¨ Discuss with physicians and anaesthetists for individual requirements.

 

Insulin and Dextrose Regime:

 

Set up 2 lines through one cannula.

 

First line: make up 50u Actrapid in 50ml normal saline in a syringe driver

Second line: put 500ml 5% dextrose through a drip counter to run over 5 hours

 

Check capillary glucose hourly and adjust insulin infusion as below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aim to keep blood glucose 4 –7 mmol/l. If failing to achieve this, check delivery for blockages etc. If everything is working and blood glucose level remains too high double the insulin infusion rates for each gradient.

 

If blood glucose >17 mmol/l and patient insulin dependent, check blood glucose with laboratory and check urine for ketones. If blood glucose confirmed change dextrose infusion to normal saline.

 

NB: Sub-cutaneous sliding scales must not be used.

Surgery will exacerbate any metabolic derangement. Patients with DM may also be at risk of coronary heart disease and autonomic dysfunction, leading to hypertension.

Diabetes