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Published on: July 30, 2011
Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes
Cindy Bredefeld1,2, Amy Patel1, Shahidul Islam3
1Department of Medicine, New York University Long Island School of Medicine, NYU Langone Hospital-Long Island, 101 Mineola Blvd, Mineola, NY 11501, USA.
Abstract:
We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.8 and 12.3 mmol/L (123 and 221 mg/dL). Our experience demonstrates that administering rapid acting insulin prior to CHO-L in patients with type 2 diabetes is feasible and targets the potentially negative influence CHO-L may impose on preoperative glycemia in this population. Important considerations of this approach are highlighted and an insulin dosing algorithm designed for non-specialty providers is suggested.
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