Table 5.

Management of insulin therapy for patients undergoing short fasting period (up to a missed meal).

Type of insulin	Previous day	Day of surgery
		Morning surgery	Afternoon surgery
Continuous subcutaneous insulin infusion (pump)	Maintain basal infusion or reduce 20–30% of baseline if history of frequent hypoglycemia
Long-acting or basal insulin (glargine, detemir)	Morning application: maintain dose Night application: maintain dose or reduce 20–30%b	Morning applicationa: Maintain dose or reduce 20–30% if history of frequent hypoglycemia. Check blood glucose at admission
Intermediate-acting insulin (NPH)	Morning application: maintain dose Night application: maintain dose or reduce 20–30%b	Reduce morning dose by 50%a; check blood glucose at admission; keep evening dose unchanged after surgery (if already fed)
Pre-mixed insulin	Maintain dose	Reduce morning dose intermediate insulin to 50%; omit the dose of fast/short-acting insulin. Check blood glucose at admission. Keep evening dose unchanged after surgery (if already fed)
Fast-acting or short-acting insulin analogs	Maintain dose	Hold dose	Hold dose

^aOn the day of surgery, the morning insulin should be given upon arrival at the health center.

^bHistory of hypoglycemia during dawn/morning.

Adapted from Refs. 2, 17, 61, 64.