Preprocedural subcutaneous insulin regimens for adults with type 1 diabetes
If the procedure is not long and complex, patients with type 1 diabetes can usually continue their usual basal insulin (either by subcutaneous injection or CSII pump); an intravenous insulin infusion is generally not needed. Withholding a basal insulin dose without starting an intravenous insulin infusion will lead to ketosis.
Adjustments to usual subcutaneous insulin dosage may be required. For advice on subcutaneous insulin management on the day of a procedure for a patient with type 1 diabetes, see Suggested subcutaneous insulin management on the day of a procedure for adults with type 1 diabetes.
For specific considerations with the use of CSII pump, see Preprocedural continuous subcutaneous insulin infusion pump management for adults with type 1 diabetes.
Usual insulin regimen: Multiple daily injection (basal–bolus) Continuous subcutaneous insulin infusion pump Fixed-dose combination (biphasic premixed or coformulation) insulin | |
Multiple daily injection (basal–bolus) | |
Insulin adjustment for a morning procedure [NB1] | Insulin adjustment for an afternoon procedure [NB1] |
Give usual dose of basal insulin while fasting [NB2]. Omit breakfast rapid- or short-acting insulin bolus dose. Give usual lunchtime rapid- or short-acting insulin bolus dose if eating. Hourly BGCs from waking. | Give usual dose of basal insulin while fasting [NB2]. Give half usual breakfast rapid- or short-acting insulin bolus dose. Omit lunchtime rapid- or short-acting insulin bolus dose. Hourly BGCs while fasting. |
Continuous subcutaneous insulin infusion pump | |
Insulin adjustment for a morning procedure [NB1] | Insulin adjustment for an afternoon procedure [NB1] |
Continue basal rate insulin infusion by pump while fasting [NB2]. Omit breakfast insulin bolus dose. Give usual lunchtime insulin bolus dose if eating. Hourly BGCs from waking. | Continue basal rate insulin infusion by pump while fasting [NB2]. Give half usual breakfast insulin bolus dose. Omit lunchtime insulin bolus dose. Hourly BGCs while fasting. |
Fixed-dose combination (biphasic premixed or coformulation) insulin | |
Insulin adjustment for a morning procedure [NB1] | Insulin adjustment for an afternoon procedure [NB1] |
Seek specialist advice or, if necessary, see suggestion for adults with type 2 diabetes in Suggested subcutaneous insulin management on the day of a procedure for adults with type 2 diabetes. | |
Note: BGC = blood glucose concentration NB1: After the procedure, basal insulin must be continued even if the patient is not eating. Mealtime insulin bolus dose can be restarted when the patient is eating. If the patient has not resumed eating normally after the procedure, the insulin dose and regimen need review. NB2: If the patient’s glycated haemoglobin (HbA1c) is 53 mmol/mol (7%) or less, recent fasting BGCs have been less than 5 mmol/L, or the patient has hypoglycaemia unawareness, then temporarily reduce the basal insulin rate or dose to 80% of the usual rate or dose (20% less than usual) while fasting. | |