How should a nurse manage insulin for a patient with type 1 diabetes who is scheduled for surgery?

For a patient with type 1 diabetes who is scheduled for surgery, the management of insulin is crucial due to the changes in metabolic demands and the potential impact of surgery on blood glucose levels. Administering half of the client's typical morning insulin dose is a common practice because it helps to balance the need for insulin while acknowledging that the patient may not be eating normally before and after surgery.

During periods of fasting, such as prior to surgery, full doses of insulin may not be necessary and could lead to hypoglycemia, especially if food intake is minimized or if the patient experiences stress from surgery, which can cause blood glucose levels to rise. Therefore, giving half of the usual morning dose can help maintain glycemic control without the risk of excessive insulin in the absence of carbohydrate intake.

Using an intravenous insulin infusion may be considered in certain scenarios, particularly in cases of more complex medical management, but it's not the standard approach for every surgical case unless specifically ordered based on the patient's condition. Administration of oral antidiabetic agents is inappropriate for a patient with type 1 diabetes as they do not produce insulin. Giving the patient's normal daily dose of insulin without adjustment could result in hypoglycemia given the likely fasting state prior to surgery.

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