We said ‘for minor elective surgery the insulin can be withheld on the day of the operation until the patient can eat’. This is true for a short minor operation performed early in the morning, but, as a correspondent has pointed out, a patient without endogenous insulin or with only brittle control whose operation happens to get delayed could quietly slip into ketoacidosis. If such a delay is likely the patient should be given an intravenous infusion of insulin and glucose as outlined for major surgery. A common regimen is to add 8 – 16 units of soluble insulin to one litre of 5% dextrose to be infused over 8 hours.
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