Continuous intravenous insulin: An evaluation in bariatric patients outside of the intensive care unit

Introduction: Bariatric surgery is being recommended for select patients with diabetes for improvement in glycemic control or possibly remission of diabetes. Diabetes remission does not happen immediately. In an effort to meet the changing glycemic control needs for bariatric surgery patients safely, a project was developed using intravenous (IV) insulin on a general surgery nursing unit. Methods: Bariatric surgery patients were identified as requiring IV insulin in the perioperative period. Nursing education was provided, and IV insulin was administered using an established tool on the general surgery floor. We retrospectively reviewed the first 10 patients treated with the protocol compared with case-matched controls. Results: The protocol was utilized in 83% of the patients meeting IV insulin criteria. No hypoglycemic events occurred. There was a significant interaction effect by treatment group and time for blood glucose during the first 24 hours postoperatively. The patients on IV insulin had a significant improvement in their blood glucose compared to the case-matched controls (p=0.011). Nursing knowledge about diabetes care demonstrated an immediate improvement in scores using a pre- and post-class paired t-test (p<0.001). However, further reassessment of knowledge level 4 months after education showed a decline in knowledge scores. Conclusions: IV insulin can be used safely and effectively in the immediate postoperative period on the general surgery nursing unit for bariatric surgery patients with diabetes. Nurses likely will require ongoing and updated knowledge in care of the inpatient with diabetes for this high risk, low frequency intervention. © Copyright 2012, Mary Ann Liebert, Inc.

Duke Scholars

Author Melanie E. Mabrey School of Nursing

Author Mary Thomson Champagne School of Nursing

Author Lisa Clark Pickett Trauma, Acute, and Critical Care Surgery