Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Management of patients with diabetes mellitus• Call doctor if blood glucose is persistently less than 4 or greaterthan 17 mmol L -1 .• Measure blood glucose every hour and adjust infusionaccordingly.• Check urea and electrolytes daily and adjust potassium chloridedose accordingly.• Caution should be exercised with fluid administration to patientswith heart failure.Intravenous fluid giving sets• The safest way to deliver insulin and IV fluids simultaneously todiabetics is via a set incorporating anti-reflux valves, through asingle cannula. These valves allow flow in one direction only.• Ordinary three way taps do not, and so should not be used.• IVAC pumps should be used to control IV fluid infusion rate andalert when the fluid bag needs replacing.Postoperative managementWhen and how to stop a sliding scale regimenGenerally, a sliding scale regimen should be stopped when thepatient is eating and drinking normally and nausea / vomiting arecontrolled.If the patient was not previously using insulin therapy, the insulin canbe stopped at any time and the usual therapy started at the time it isusually given.If the patient was previously using insulin therapy, the insulin,dextrose potassium regimen should only be stopped at meal time:• Provide the meal.• Give the pre-meal insulin.• Stop the insulin, dextrose, potassium regimen one hour later.Anaesthetists Handbook January 2010 161