Management of diabetes during surgery with glucose-insulin-potassium infusion.
One hundred and twenty-eight surgical operations in diabetic patients have been studied to assess the effectiveness, under routine clinical conditions, of a management regimen based on the use of glucose-insulin-potassium infusion (GIK). Forty-four non-insulin-dependent diabetic (NIDDM) and 41 insulin-dependent diabetic (IDDM) patients received GIK. Mean blood glucose on the day of operation was 9.3 +/- S.D. 2.2 mmol/l in NIDDM and 8.9 +/- 2.3 mmol/l in IDDM patients. Acceptable control on the day of operation (defined as mean blood glucose 5-12 mmol/l without hypoglycaemia) was achieved in 70 (82%) patients. Eleven of 15 failures were attributable to incorrect implementation of the protocol. Though 10 units Soluble insulin/500 ml 10% glucose (0.32 units/g glucose) was needed in 61% of patients, 26% required a higher and 13% a lower dose. Plasma potassium concentration did not change after 24 h of GIK infusion, but sodium concentration fell (136 +/- 5 to 132 +/- 5 mmol/l; p less than 0.01), with 12 of 32 patients having post-operative values less than 130 mmol/l. Forty-three NIDDM patients undergoing minor surgery were managed without insulin, and acceptable control was achieved in 40 (93%). We conclude that the regimen described is a satisfactory routine means of managing diabetes during surgery, but that optimal results depend on careful monitoring with appropriate alteration of therapy.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood; D008875:Middle Aged; D011188:Potassium / Q000008:administration & dosage*; D011300:Preoperative Care; D011446:Prospective Studies; D013514:Surgical Procedures, Operative
D001786:Blood Glucose; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium