Basic Concepts of Fluid and Electrolyte Therapy

Surgery in the patient with diabetes:
(based on NHS Diabetes recommendations)
Peri-operative glucose control
For short procedures, involving missing no more than one meal, particularly
in type 2 diabetes, the normal treatment may be delayed
until post-operatively, with hourly monitoring of blood glucose and
treatment with insulin if blood glucose rises above 12.0 mmol/l.
Those expected to miss more than 1 meal, particularly Type 1 patients
should receive variable rate insulin infusion (VRII) to maintain blood
glucose within the range 4-12 mmol/l as shown by hourly monitoring.
Insulin should be administered in 0.45% saline with 5% glucose and
0.15-0.3% KCl via a syringe pump, starting approximately 6 hours
preoperatively and continuing post-operatively until normal oral
intake is established.
Perioperative fluid and electrolyte management
The principles are the same as those we have outlined for the nondiabetic.
In the type 1 diabetic, however, in order to avoid ketosis, it is
useful to have a constant rate of infusion of a crystalloid containing
5% glucose with appropriate VRII cover. This can be achieved using
0.45% saline with 5% dextrose and 0.15-0.3% KCl. Alternatively, if a
balanced electrolyte solution is preferred, use Plasmalyte Maintenance
(Chapter 5).
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