Abstract • This report is a sequel to "Why Control Blood Glucose Levels?" (Arch Surg 111:229, 1976), which linked complications of diabetes mellitus to poor control. Hyperglycemia, increased gluconeogenesis, nitrogen wasting, and increased ketogenesis occur in the perioperative period, partly as a result of contrainsulin hormones provoked by stress and trauma. These untoward events are aggravated in the diabetic. Zones of levels of blood glucose control are charted, as well as the corresponding insulin needs for each of these zones. Intermediate insulins should provide basic coverage; regular insulin is recommended only as a supplement. Several blood glucose determinations per day are necessary to maintain control. The hazards of dependence on urine testing and the "sliding scale" for control are among a number of caveats discussed. (Arch Surg 111:945-949, 1976) References 1. Rossini AA: Why control blood glucose levels? Arch Surg 111:229-233, 1976.Crossref 2. Marble A, Steinke J: Physiology and pharmacology in diabetes mellitus: Guiding the diabetic patient through the surgical period . Anesthesiology 24:442-447, 1963.Crossref 3. Henneman DH, Vandam LD: The metabolic consequences of epinephrine and insulin administered during ether anesthesia in man . Anesthesiology 19:104, 1958.Crossref 4. Clarke RSJ: The hyperglycaemic response to different types of surgery and anesthesia . Br J Anaesth 42:45-53, 1970.Crossref 5. Beaser SB: Surgical management , in Ellenberg M, Rifkin H (eds): Diabetes Mellitus: Theory and Practice . New York, McGraw-Hill Book Co Inc, 1970, pp 746-759. 6. Allison SP, Tomlin PJ, Chamberlin MJ: Some effects of anesthesia and surgery on carbohydrate and fat metabolism . Br J Anaesth 41:588-593, 1969.Crossref 7. Moore FD, Ball MR: The Metabolic Response to Surgery . Springfield, Ill, Charles C Thomas Publisher, 1952. 8. Meguid MM, Brennan MF, Aoki TT, et al: Hormone-substrate interrelationships following trauma . Arch Surg 109:776-783, 1974.Crossref 9. Long CL, Spencer JL, Kinney JM, et al: Carbohydrate metabolism in man: Effect of elective operations and major injury . J Appl Physiol 31:110-116, 1971. 10. Hinton P, Allison SP, Littlejohn S, et al: Insulin and glucose to reduce catabolic response to injury in burned patients . Lancet 1:767-769, 1971.Crossref 11. Joslin EP, Root HF, White P, et al: The Treatment of Diabetes Mellitus , ed 11. Philadelphia, Lea & Febiger, 1971. 12. Kleeman CR, Liberman B: Diabetic acidosis and coma , in Maxwell MH, Kleeman CR (eds): Clinical Disorders of Fluid and Electrolyte Metabolism . New York, McGraw-Hill Book Co Inc, 1972. 13. Campbell IW, Duncan LJP, Innes JA, et al: Abdominal pain in diabetic decompensation: Clinical significance . JAMA 233:166-168, 1975.Crossref 14. Galloway JA, Shuman CR: Diabetes and surgery: A study of 667 cases . Am J Med 34:177-191, 1963.Crossref 15. Feldman JM, Lebovitz FL: Tests for glycosuria: An analysis of factors that cause misleading results . Diabetes 22:115-121, 1973.
Archives of Surgery – American Medical Association
Published: Sep 1, 1976