Who Monitor Blood Sugar at Home

On the evening before your operation:
If you take Insulin Glargine (Lantus) or Ultralente before bed, take 2/3 of your usual dose.

Upon awakening the morning of your operation:
Check your blood sugar. Choose the next step based on your blood sugar result.

If your blood sugar is 70 mg/dl or less and you are being treated with diabetes medications that can cause LOW BLOOD SUGAR:

• Do not take any of your usual insulin or oral diabetes medications. If you use the insulin pump, adjust your basal insulin dose (if appropriate) using your home algorithm.
• Do not treat with candy or solid food! Treat the low blood sugar by taking one of the following:
  • 2/3 cup cranberry juice
  • 15 grams of instant glucose gel
  • 1 cup of apple juice
  • 1 - 8 oz. glass of water with 6 teaspoons of sugar
  • 1 cup of regular soft drink
• Call the hospital / health center:
  • Before 6:30 a.m., call 517-545-6000 and ask for the house supervisor. This is for both the hospital and health center.
  • After 6:30 a.m., call the location of your operation:
  - St. Joseph Mercy Livingston Hospital, 517-545-6147
  - St. Joseph Mercy Woodland Health Center, 810-844-7733

You will be instructed what to do about your insulin (if you take insulin at home) and when to come to the hospital.

If your blood sugar is 71 to 199 mg/dl:

• Do not take any oral diabetes medications.
• Do not take any Regular, Lispro (Humalog) or Aspart (Novolog) insulin by syringe.
• If taking insulin by syringe, give:
  • One-half (1/2) of your usual morning dose of NPH, Lente or Premixed (70/ 30, 50/50 or 75/25) insulin
  • 2/3 of your usual dose of Glargine (Lantus) or Ultralente insulin.
  When: At the time the usual morning dose of insulin is due.
• If taking insulin by insulin pump:
  • Do not give meal bolus doses of insulin.
  • Continue infusing basal insulin. Adjust the basal insulin dose if basal rates are likely to cause the blood sugar to rise or fall when you are stressed or not eating.
• Check your blood sugar every four hours until you come to the hospital. If at any time your blood sugar is:
  • 70 mg/dl or less, refer to the section entitled, 'If your blood sugar is 70 mg/dl or less and you are being treated with diabetes medications that can cause low blood sugar.'
  • 200 mg/dl or more, refer to the section immediately below entitled, 'If your blood sugar is 200 mg/dl or more.'

If your blood sugar is 200 mg/dl or more:

• Do not take any oral diabetes medications.
• Do not take your usual dose of Regular, Lispro (Humalog) or Aspart (Novolog) insulin by syringe.
• If you have written guidelines for treating high blood sugar, treat the high blood sugar using the prescribed guidelines.
• If taking insulin by syringe or insulin pump, give insulin as described in the section entitled, 'If your blood sugar is 71 to 199 mg/dl.'
• Call the hospital / health center:
  • Before 6:30 a.m., call 517-545-6000 and ask for the house supervisor.
  • After 6:30 a.m., call
  - St. Joseph Mercy Livingston Hospital, 517-545-6147
  - St. Joseph Mercy Woodland Health Center, 810-844-7733

You will be instructed when to come to the hospital.

Instructions for Persons with Diabetes Who DO NOT Monitor Blood Sugar at Home

On the evening before your operation:
If you take Insulin Glargine (Lantus) or Ultralente before bed, take 2/3 of your usual dose.

Upon awakening the morning of your operation:

• Do not take any oral diabetes medications.
• Do not take any of your usual Regular insulin, Lispro (Humalog), or Aspart (Norolog)

If you have signs / symptoms of LOW BLOOD SUGAR upon awakening AND you are being treated with diabetes medications that can cause low blood sugar:

• Do not take any insulin (if you take insulin).
• Do not treat with candy or solid food! Treat the low blood sugar by taking one of the following:
  • 2/3 cup cranberry juice
  • 15 grams of instant glucose gel
  • 1 cup of apple juice
  • 1 glass of water with 6 teaspoons of sugar
  • 1 cup of regular soft drink
• Call the hospital:
  • Before 6:30 a.m., call 517-545-6000 and ask for the house supervisor.
  • After 6:30 a.m., call
  - St. Joseph Mercy Livingston Hospital, 517-545-6147
  - St. Joseph Mercy Woodland Health Center, 810-844-7733

You will be instructed what to do about your insulin (if you take insulin at home) and when to come to the hospital.

If you DO NOT have signs/symptoms of LOW or HIGH BLOOD SUGAR upon awakening:

• Take the following insulin amount:
  • One-half (1/2) of your usual morning dose of NPH, Lente or Premixed (70/ 30, 50/50 or 75/25) insulin.
  • 2/3 of your usual dose of Glargine (Lantus) or Ultralente insulin.
  When: At the time the usual morning dose of insulin is due.
• Await the time you were told to report to the hospital.
• Be alert for any signs/symptoms of low or high blood sugar. If at any time you have:
  • Signs or symptoms of low blood sugar, refer to 'If you have signs/symptoms of low blood sugar upon awakening and you are being treated with diabetes medications that can cause low blood sugar.'
  • Signs or symptoms of high blood sugar, refer to 'If you have signs/symptoms of high blood sugar upon awakening.'

If you have signs/symptoms of HIGH BLOOD SUGAR upon awakening:

• Take your insulin as described in the section, 'If you do not have signs/symptoms of low or high blood sugar upon awakening.'
• Call the hospital / health center:
  • After 6:30 a.m., call
  - St. Joseph Mercy Livingston Hospital, 517-545-6147
  - St. Joseph Mercy Woodland Health Center, 810-844-7733
  • Before 6:30 a.m., call 517-545-6000 and ask for the house supervisor.

You will be instructed when to come to the hospital.