Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes
We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received r...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | Surgery Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589845024000277 |
| _version_ | 1797226640069099520 |
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| author | Cindy Bredefeld, DO, FACE, FNLA Amy Patel, MD Shahidul Islam, DrPH Virginia Peragallo-Dittko, RN, BC-ADM, CDCES, FADCES, FAAN |
| author_facet | Cindy Bredefeld, DO, FACE, FNLA Amy Patel, MD Shahidul Islam, DrPH Virginia Peragallo-Dittko, RN, BC-ADM, CDCES, FADCES, FAAN |
| author_sort | Cindy Bredefeld, DO, FACE, FNLA |
| collection | DOAJ |
| description | We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.8 and 12.3 mmol/L (123 and 221 mg/dL). Our experience demonstrates that administering rapid acting insulin prior to CHO-L in patients with type 2 diabetes is feasible and targets the potentially negative influence CHO-L may impose on preoperative glycemia in this population. Important considerations of this approach are highlighted and an insulin dosing algorithm designed for non-specialty providers is suggested. |
| first_indexed | 2024-03-07T16:53:13Z |
| format | Article |
| id | doaj.art-9844825e26384807b34bf511d3987e2d |
| institution | Directory Open Access Journal |
| issn | 2589-8450 |
| language | English |
| last_indexed | 2024-04-24T14:28:07Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj.art-9844825e26384807b34bf511d3987e2d2024-04-03T04:27:19ZengElsevierSurgery Open Science2589-84502024-03-0118107110Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetesCindy Bredefeld, DO, FACE, FNLA0Amy Patel, MD1Shahidul Islam, DrPH2Virginia Peragallo-Dittko, RN, BC-ADM, CDCES, FADCES, FAAN3Department of Medicine, New York University Long Island School of Medicine, NYU Langone Hospital—Long Island, 101 Mineola Blvd, Mineola, NY 11501, USA; Department of Foundations of Medicine, New York University Long Island School of Medicine, NYU Langone Hospital—Long Island, 101 Mineola, Mineola, NY 11501, USA; Corresponding author at: 101 Mineola Blvd. 2nd Flr., Mineola, NY 11501, USA.Department of Medicine, New York University Long Island School of Medicine, NYU Langone Hospital—Long Island, 101 Mineola Blvd, Mineola, NY 11501, USADivision of Health Services Research, Research and Academic Center, NYU Long Island School of Medicine, NYU Langone Hospital—Long Island, 101 Mineola Blvd, Mineola, NY 11501, USADepartment of Medicine, New York University Long Island School of Medicine, NYU Langone Hospital—Long Island, 101 Mineola Blvd, Mineola, NY 11501, USA; Department of Foundations of Medicine, New York University Long Island School of Medicine, NYU Langone Hospital—Long Island, 101 Mineola, Mineola, NY 11501, USAWe assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.8 and 12.3 mmol/L (123 and 221 mg/dL). Our experience demonstrates that administering rapid acting insulin prior to CHO-L in patients with type 2 diabetes is feasible and targets the potentially negative influence CHO-L may impose on preoperative glycemia in this population. Important considerations of this approach are highlighted and an insulin dosing algorithm designed for non-specialty providers is suggested.http://www.sciencedirect.com/science/article/pii/S2589845024000277Enhanced recovery after surgery (ERAS)Carbohydrate loadingDiabetes |
| spellingShingle | Cindy Bredefeld, DO, FACE, FNLA Amy Patel, MD Shahidul Islam, DrPH Virginia Peragallo-Dittko, RN, BC-ADM, CDCES, FADCES, FAAN Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes Surgery Open Science Enhanced recovery after surgery (ERAS) Carbohydrate loading Diabetes |
| title | Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes |
| title_full | Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes |
| title_fullStr | Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes |
| title_full_unstemmed | Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes |
| title_short | Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes |
| title_sort | enhanced recovery after surgery preoperative carbohydrate loading and insulin management in type 2 diabetes |
| topic | Enhanced recovery after surgery (ERAS) Carbohydrate loading Diabetes |
| url | http://www.sciencedirect.com/science/article/pii/S2589845024000277 |
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