What is the most appropriate management for insulin in a patient scheduled for a hernia operation?

In patients with diabetes undergoing surgery, it is essential to maintain adequate blood glucose control to prevent complications such as infections and delayed healing. The correct approach is to provide insulin in a way that accommodates the stress of surgery while ensuring the patient does not experience hyperglycemia.

Administering intravenous (IV) insulin along with dextrose and saline is optimal because it allows for continuous monitoring and adjustment of glucose levels in response to the surgical stress. Dextrose is included to prevent hypoglycemia that might result from administering insulin alone, especially when the patient may not be able to eat or drink during the perioperative period.

This method ensures a controlled and safe management of blood glucose, minimizing the risk of both hyperglycemia and hypoglycemia. It is particularly vital for patients who are on insulin therapy, as they require careful balancing around the time of surgery to maintain stable glucose levels.

Other management strategies, such as stopping insulin completely or giving insulin as usual without adjustments, do not provide the same level of control and risk either hypoglycemia or persistent hyperglycemia, which can lead to adverse outcomes.