title: Intraoperative glucose control in diabetic and nondiabetic patients during cardiac surgery.
abstract: OBJECTIVE
  The purpose of this study was to evaluate intraoperative glucose control.
  
  
  METHODS
  Prospective unblinded study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Diabetic (n = 17) and nondiabetic (n = 23) patients undergoing elective cardiac surgery.
  
  
  METHODS
  Diabetics received a modified insulin regimen consisting of a fixed rate infusion of regular insulin, 10 U/m2/h, and a variable infusion of D10W, adjusted to maintain glucose between 101 to 140 mg/dL.
  
  
  RESULTS
  Baseline glucose was higher in diabetics versus nondiabetics (mean +/- standard error of the mean: 203 +/- 27 v 117 +/- 3 mg/dL, p < 0.005). After baseline, insulin levels were increased in diabetics to 410 to 568 microU/mL. Corresponding insulin levels in nondiabetics were 12 to 40 microU/mL. Compared with baseline, glucose was decreased by 10% +/- 29% in diabetics during hypothermic cardiopulmonary bypass and increased by 21% +/- 30% in nondiabetics (p < 0.005). After discontinuation of bypass, glucose was lower in diabetics (137 +/- 12 mg/dL) versus nondiabetics (162 +/- 8 mg/dL, p < 0.005). Nine diabetics had adequate intraoperative glycemic control during hypothermic bypass (glucose 123 +/- 8 mg/dL, insulin 550 +/- 68 microU/mL, glucose infusion rate 1.87 +/- 0.29 mg/kg/min), 6 approached adequate control near the end of surgery (glucose 147 +/- 8 mg/dL, insulin 483 +/- 86 microU/mL, glucose infusion rate 0.35 +/- 0.05 mg/kg/min), and 2 never achieved control. Diabetics with elevated initial glucose >300 mg/dL did not achieve adequate glycemic control. Four diabetics (3 with renal failure) required injection of 50% dextrose after bypass for hypoglycemia.
  
  
  CONCLUSIONS
  Adequate glycemic control can be achieved in most diabetics during cardiac surgery using a modified insulin clamp technique provided initial glucose is <300 mg/dL.
authors.affiliation: Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA. csmith@metrohealth.org
authors.forename: Charles E
authors.initials: CE
authors.lastname: Smith
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Styn
authors.forename: Satish
authors.initials: S
authors.lastname: Kalhan
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Pinchak
authors.forename: Inderjit S
authors.initials: IS
authors.lastname: Gill
authors.forename: Richard P
authors.initials: RP
authors.lastname: Kramer
authors.forename: Tejbir
authors.initials: T
authors.lastname: Sidhu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007333:Insulin Resistance; D007431:Intraoperative Complications / Q000453:epidemiology; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013610:Tachycardia / Q000453:epidemiology / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin; D014409:Tumor Necrosis Factor-alpha; D019382:Human Growth Hormone; D019344:Lactic Acid; D006854:Hydrocortisone