Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Management of patients with diabetes mellitusInsulin sliding scale regime• Prescribe IV infusion of 50 units Human Actrapid in 50 mL withnormal saline, (1 unit mL -1 ).• Prescribe IV fluid: 5% dextrose unless otherwise indicated. Addpotassium chloride if indicated.• Commence insulin infusion rate according to result of capillaryblood sample.Teststickglucose17 6Insulininfusion ratein units h -1Fluid RegimenGive 20 mL of dextrose 50% ifsymptomatic (incoherent orunrousable), or increase the dextrose5% infusion rate by 50 mL h -1 . i.e. to135 mL h -1 . Re-check blood glucose in30 minutes.1000mL 5% dextrose with 40 mmol L -1KClStart and continue infusion at125 mL h -1 (1000 mL in 12 hours) untilinsulin infusion ceases.Prescribe additional fluid requirementsseparately.1000 mL of 0.9% normal saline with40 mmol L -1 KClStart and continue infusion at85 mL h -1 (1000 mL in 12 hours) untilinsulin infusion ceases.160 Anaesthetists Handbook January 2010