What is the recommended procedure for transitioning a patient with type 1 diabetes from VRIII to subcutaneous insulin after surgery?

For a patient with type 1 diabetes, transition from VRIII to subcutaneous insulin should be made when the next meal-related insulin dose is due. Give the subcutaneous insulin with the meal and stop the VRIII 30 minutes later. If the long-acting basal insulin was stopped perioperatively in error, keep the VRIII running until that basal dose has been given.

Post-operatively, management should return to the patient's usual subcutaneous regimen as soon as the patient is eating. The transition from VRIII to subcutaneous insulin should take place when the next meal-related dose is due. Insulin should be given with the meal, and the VRIII can then be stopped 30 minutes later, allowing the subcutaneous insulin time to start working before the intravenous infusion is removed. If the long-acting insulin had been stopped perioperatively in error, the VRIII should be continued until a dose of the long-acting insulin is given. For patients on a continuous subcutaneous insulin infusion pump, the pump can be restarted once the patient is able to manage it, and there needs to be an overlap of 60 minutes from recommencing the CSII pump to stopping the VRIII. After VRIII is discontinued, capillary blood glucose levels should be monitored hourly for at least 2 hours; if readings are in an acceptable range, follow the local glucose monitoring policy. Consult the inpatient diabetes team if there is recurrent hyperglycaemia or hypoglycaemia.