From the Guidelines
Insulin infusion (gtt) is recommended after orthopedic surgery to maintain blood glucose levels below 180 mg/dL, as this target range is associated with reduced morbidity and mortality, and improved quality of life, particularly in patients with diabetes or stress-induced hyperglycemia. The typical approach involves starting an insulin infusion when glucose exceeds 180 mg/dL, using regular insulin at an initial rate of 1-2 units/hour, with adjustments based on hourly glucose measurements, as suggested by the 2020 standards of medical care in diabetes 1. This glucose control is important because hyperglycemia (>180 mg/dL) increases the risk of surgical site infections, impairs wound healing, and can lead to other postoperative complications. The physiological stress of surgery triggers insulin resistance and increased glucose production, which can significantly elevate blood glucose levels even in non-diabetic patients. For patients without diabetes who develop transient hyperglycemia, the insulin infusion can typically be discontinued once glucose levels normalize and the stress response subsides, usually within 24-48 hours post-surgery.
Some key considerations for insulin infusion after orthopedic surgery include:
- Monitoring blood glucose at least every 4-6 hours while the patient is taking nothing by mouth, and dosing with short- or rapid-acting insulin as needed 1
- Withholding oral glucose-lowering agents the morning of surgery, and giving half of the NPH dose or 60-80% of the doses of long-acting analog or pump basal insulin 1
- Targeting a blood glucose range of 80-180 mg/dL (4.4-10.0 mmol/L) in the perioperative period, as recommended by the 2020 standards of medical care in diabetes 1
It's worth noting that while the provided evidence includes guidelines for coronary artery bypass graft surgery 1, the most recent and relevant guideline for diabetes care in the hospital is the 2020 standards of medical care in diabetes 1, which provides specific recommendations for perioperative care and blood glucose targets.
From the Research
Insulin Therapy in Orthopedic Surgery
- The provided studies do not directly address the question of whether insulin gtt is recommended after orthopedic surgery to keep glucose less than 200 2, 3, 4, 5, 6.
- However, the studies suggest that managing blood glucose levels is crucial in patients with diabetes undergoing orthopedic surgery to reduce the risk of postoperative complications 2, 3.
- The studies also discuss the importance of individualized insulin therapy and glycemic control in patients with diabetes, but do not provide specific recommendations for insulin gtt after orthopedic surgery 4, 5.
- One study highlights the need for guidelines on managing insulin pump-treated patients undergoing surgery, which may be relevant to insulin gtt management 6.
- Another study compares the efficacy and safety of glargine and detemir insulin in managing inpatient hyperglycemia and diabetes, but does not address insulin gtt specifically 5.
Glycemic Control in Orthopedic Surgery
- Elevated blood glucose levels have been associated with increased risk of complications in orthopedic patients, emphasizing the need for effective glycemic control 2, 3.
- The target blood glucose level is not explicitly stated in the provided studies, but maintaining glucose at safe levels while avoiding hyperglycemia and hypoglycemia is recommended 2, 4.
- The studies suggest that individualized insulin therapy and glycemic control can help mitigate the risks associated with diabetes in orthopedic patients, but do not provide specific guidance on insulin gtt after orthopedic surgery 4, 5, 6.