Diabetes Mellitus Management after Open Heart Surgery :  Diabetic patients undergoing coronary artery bypass surgery who are on oral hypoglycemic drugs are pre operatively stabilized with insulin.

In the immediate post-operative period, blood sugar levels remain high because of stress and exogenous and endogenous catecholamines. Blood sugar is checked two hourly and controlled with plain insulin intravenously according to a sliding scale. Now it is felt that a strict control of sugar is necessary in the postoperative period. The sliding scale is as follows:

If the intravenous fluid is 5 per cent dextrose, it is covered with 10 units of insulin/500 ml bottle. On the first post-operative day when the sugars are stabilized, insulin is made subcutaneous 4-6 hourly, using sliding scale. Blood sugar should be kept below 160 mg per cent.

Before discharge from hospital, patient is put back on to his original oral hypoglycemic agents. It is very important to have tight control (fasting blood sugar 80-100 mg per cent) of diabetes in all post CABG patients. If it is very long standing diabetes and if it is not well controlled with oral hypoglycaemic agents, insulin regime is started.