Abstract

Purpose/Background:

Perioperative hyperglycemia affects 20–40% of surgical patients and increases risk of infections, delayed wound healing, and prolonged hospital stays. The American Diabetes Association recommends maintaining blood glucose (BG) levels between 140–180 mg/dL, while the Society for Ambulatory Anesthesia recommends BG remain below 180 mg/dL. In addition to insulin regular infusions for longer, complex procedures, management also includes intravenous push (IVP) or subcutaneous (SC) insulin with differences in pharmacokinetic properties and risk of hypoglycemia. With varying insulin administration practices at our institution, this project aimed to evaluate the impact of perioperative insulin administration strategies on achieving target glycemic goals.

Methods:

This multisite, retrospective, quality improvement project was conducted across seven hospitals within Baptist Health South Florida from October 2024 to September 2025. Adult patients who received preoperative regular insulin administration via IVP or SC route were included. Patients were excluded if they were pregnant, incarcerated, undergoing cardiac surgery, or received insulin for hyperkalemia treatment.

Of the 74 patients who met initial screening criteria, 20 patients who did not have repeat preoperative BG levels were excluded. The final analysis consisted of 30 patients who received IVP insulin and 24 who received SC insulin. Baseline characteristics were similar between groups, including gender distribution, mean age, weight, past medical history of diabetes, and mean hemoglobin A1c.

The primary outcome was the percent of patients achieving target BG levels of 140–180 mg/dL following preoperative insulin administration. Secondary outcomes included mean preoperative insulin dose, time to repeat BG measurement and value prior to surgery, mean absolute and percent reduction in BG, incidence of hypoglycemic events, postoperative infections, and hospital length of stay.

Results:

The majority of patients had suboptimal baseline glycemic control reflected by mean hemoglobin A1c of 8.8% vs. 8.3% and BG levels of 288 mg/dL vs. 291 mg/dL, respectively.  Achievement of target BG following preoperative insulin administration was low, occurring in 2 (7%) IVP patients and 2 patients (8%) in the SC group. For secondary outcomes, the mean preoperative insulin dose was similar between groups (0.07 vs. 0.08 units/kg for IVP and SC, respectively). The mean time to repeat BG monitoring was 117 ± 94 minutes in the IVP group and 118 ± 104 minutes in the SC group. Mean preoperative BG prior to surgery was 238 ± 42 mg/dL in the IVP group and 251 ± 61 mg/dL in the SC group. Mean absolute BG reduction was 51 ± 48 mg/dL in the IVP group vs. 41 ± 35 mg/dL in the SC group, corresponding to mean percentage reductions of 16% and 14%. No hypoglycemic events were observed. Postoperative infections occurred in three IVP insulin patients (7%) and one SC insulin patient (3%). Mean hospital length of stay was 4 days in both groups. Stratification by baseline BG did not demonstrate a significant difference between routes of administration.

Conclusion:

Intravenous push and subcutaneous insulin demonstrated similar effects on preoperative glycemic control, with no hypoglycemic events observed in either group. Despite these findings, achievement of target preoperative glucose levels remained low, highlighting opportunity for optimization of management strategies. Implementation of a standardized perioperative insulin protocol may improve glycemic management and enhance patient outcomes.

Publication Date

Spring 5-15-2026

Presented At:

Florida Residency Conference

Content Type

Presentation

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