Comparison of a continuous glucose-insulin-potassium infusion versus intermittent bolus application of insulin on perioperative glucose control and hormone status in insulin-treated type 2 diabetics.
OBJECTIVE
To compare the effect of two different perioperative insulin management regimes on patients undergoing either major surgery (vascular surgery) or minor surgery (vitrectomy).


METHODS
Prospective, double-blind randomized trial.


METHODS
48 insulin-treated type 2 diabetics aged 18 to 85 years were studied.


METHODS
University medical center.


METHODS
Patients were divided into four groups of 12 patients each: Groups A and B (major surgery), Groups C and D (minor surgery). Group A and C patients were treated with a continuous modified glucose-insulin-potassium infusion according to blood glucose levels after intubation. Patients assigned to Groups B and D were treated with intermittent intravenous (IV) insulin injections when glucose levels exceeded 12 mmol L(-1).


METHODS
Glucose and potassium levels were measured every 15 minutes and 30 minutes during surgery and up to 4 hours post-surgery. Plasma levels of lactate, cortisol, glycerol, and free fatty acids were measured in arterial samples after intubation (S1), after extubation (S2), and 4 hours after surgery (S3).


RESULTS
There were no significant differences of the patient characteristics among the four groups. There was no significant difference in the time course of plasma glucose levels and hormone variables measured among the four groups. One episode of hyperglycemia in Group D during the postoperative period was treated with 12 IV units of insulin. One patient in Group A and one in Group B received potassium intraoperatively (15 and 29 mmoL, respectively). Postoperatively, two other patients of Group A received 19 and 12,5 mmoL, respectively, and one of Group B received 20 mmoL potassium.


CONCLUSIONS
Both regimens resulted in relatively stable and comparable blood glucose levels throughout the perioperative period of the minor and major surgeries without differences in metabolic control as measured by levels of lactate, cortisol, glycerol and free fatty acids. Simplicity would favor the intermittent regimen to manage insulin treated type 2 diabetics.
Hemmerling
T M
TM
Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany. thomas-hemmerling@hotmail.com
Schmid
M C
MC
Schmidt
J
J
Kern
S
S
Jacobi
K E
KE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D004311:Double-Blind Method; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology*; D005990:Glycerol / Q000097:blood; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology*; D007432:Intraoperative Period; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011188:Potassium / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D006728:Hormones; D007004:Hypoglycemic Agents; D007328:Insulin; D019344:Lactic Acid; D005947:Glucose; D005990:Glycerol; D011188:Potassium; D006854:Hydrocortisone