British Journal of Anaesthesia, Vol 76, Issue 2 198-202, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. Raucoules-Aime, Y. Labib, J. Levraut, P. Gastaud, C. Dolisi and D. Grimaud
We conducted a randomized, prospective study to assess the effect of i.v.
insulin on blood glucose control, development of ketone bodies and hormonal
changes in 60 well-controlled, non-insulin-dependent diabetics (NIDDM)
undergoing major surgery. In group A, patients were given only 0.9% saline;
in group B, patients were given insulin as a continuous i.v. infusion (1.25
u. h-1); in group C, patients were given insulin 10 u. i.v. boluses every 2
h. Patients in all three groups were given insulin 5 u. when their
intraoperative blood glucose concentration increased to greater than 11.1
mmol litre-1. Blood glucose concentrations were measured every 15 min, from
just before induction of anaesthesia to 2 h after surgery. Plasma lactate,
pyruvate, ketone body, C-peptide and counter-regulatory hormone
concentrations were also measured. Blood glucose concentrations in the
three groups did not differ significantly. There was a mild-to-moderate
increase in plasma ketone body concentrations in group A, but without any
deleterious consequences. Plasma C-peptide concentrations decreased
significantly in groups B and C, especially in patients given bolus
injections of insulin. Plasma growth hormone concentrations also increased
significantly in group B and C patients. This study indicated that the "no
insulin--no glucose" regimen was a simple, effective way to control blood
glucose in well-controlled NIDDM patients, provided blood glucose was
measured frequently and insulin used appropriately.
CLINICAL INVESTIGATIONS
Use of i.v. insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery
Department of Anaesthesia, Hopital Saint-Roch, 5 rue P. Devoluy, Centre Hospitalier et Universitaire, 06006 Nice Cedex 1, France; Department of Ophthalmology, Hopital Saint-Roch, 5 rue P. Devoluy, Centre Hospitalier et Universitaire, 06006 Nice Cedex 1, France; Department of Physiology, Hopital Saint-Roch, 5 rue P. Devoluy, Centre Hospitalier et Universitaire, 06006 Nice Cedex 1, France
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