Another simple regimen for perioperative management of diabetes mellitus

Table 1 Ram’s regimen (dose of insulin)* Target glucose level 140-180 mg/dL.

Condition of the patient	Dose of insulin,i.e.,units of insulin per gram of dextrose per hour (U/g per hour)[6]	Total insulin in 500 mL of 5% dextrose isotonic saline solution
General guideline	0.2-0.4	5 to 10 U
Obese/hepatic dysfunction	0.6	15 U
Severe infections/sepsis/steroid therapy	0.6-0.8	15 to 20 U

* The dose of insulin can be chosen based on the clinical condition mentioned above as well as other factors such as preoperative requirement of insulin/other anti-diabetic drugs, the preoperative blood glucose level. The solution can be administered at 100 mL/hour. Check capillary glucose two hourly for the first four hours. Add 1 U of insulin per hour for every 50 mg of rising of glucose level above 180 mg (e.g., If it is 280 mg after two hours, it would become 2 U/h,i.e., 6 U for the remaining 300 mL of solution). If the glucose level is between 100 and 140 mg, start 10% dextrose at 50 mL per hour simultaneously, and reduce the insulin dose by 0.5 U per hour in the subsequent preparations. If <100mg, give only 10% dextrose until it reaches 140mg, and reduce the insulin dose by 1 U per hour (minus five of total dose calculated previously) in the subsequent preparations. Once stabilized, the capillary glucose can be checked every four hours. Potassium can be added if required as in cases of (1)hypokalemia; (2)gastrointestinal procedures; and (3)requirement of infusion for more than five hours.