Perioperative insulin therapy

Leurcharusmee, Prangmalee; Kositratna, Guy; Tran, De Q.; Schricker, Thomas

doi:10.1515/abm-2018-0014

Abstract

Surgical patients commonly develop hyperglycemia secondary to the neuroendocrine stress response. Insulin treatment of hyperglycemia is required to overcome the perioperative catabolic state and acute insulin resistance. Besides its metabolic actions on glucose metabolism, insulin also displays nonmetabolic physiological effects. Preoperative glycemic assessment, maintenance of normoglycemia, and avoidance of glucose variability are paramount to optimize surgical outcomes. This review discusses the basic physiology and effects of insulin as well as practical issues pertaining to its management during the perioperative period.

References

Fu Z, Gilbert ER, Liu D. Regulation of insulin synthesis and secretion and pancreatic beta-cell dysfunction in diabetes. Curr Diabetes Rev. 2013; 9:25–53.
Search in Google Scholar Back to article
Jones AG, Hattersley AT. The clinical utility of C-peptide measurement in the care of patients with diabetes. Diabet Med. 2013; 30:803–17.
Search in Google Scholar Back to article
Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005; 26:19–39.
Search in Google Scholar Back to article
Sharp GW. Mechanisms of inhibition of insulin release. Am J Physiol. 1996; 271:C1781–99.
Search in Google Scholar Back to article
Korytkowski MT. In-patient management of diabetes: controversies and guidelines. Indian J Endocrinol Metab. 2013; 17:S630–5.
Search in Google Scholar Back to article
Redmon B, Caccamo D, Flavin P, Michels R, O’Connor P, Roberts J, et al. Inpatient diabetes management. In: Institute for Clinical Systems Improvement, editors. Diagnosis and management of type 2 diabetes mellitus in adults. 16th ed. [online]. 2014 [cited 2017 Sept 01]; Available from: https://www.ohcoop.org/wp-content/uploads/Clinical-Guidelines-Type-2-Diabetes-in-Adults.pdf
Search in Google Scholar Back to article
Polonsky KS, Given BD, Hirsch L, Shapiro ET, Tillil H, Beebe C, et al. Quantitative study of insulin secretion and clearance in normal and obese subjects. J Clin Invest. 1988; 81:435–41.
Search in Google Scholar Back to article
Akhtar S, Barash PG, Inzucchi SE. Scientific principles and clinical implications of perioperative glucose regulation and control. Anesth Analg. 2010; 110:478–97.
Search in Google Scholar Back to article
Dimitriadis G, Mitrou P, Lambadiari V, Maratou E, Raptis SA. Insulin effects in muscle and adipose tissue. Diabetes Res Clin Pract. 2011; 93:S52–9.
Search in Google Scholar Back to article
Girard M, Schricker T. Perioperative glucose control: living in uncertain times—continuing professional development. Can J Anaesth. 2011; 58:312–20.
Search in Google Scholar Back to article
Dandona P, Aljada A, Mohanty P, Ghanim H, Bandyopadhyay A, Chaudhuri A. Insulin suppresses plasma concentration of vascular endothelial growth factor and matrix metalloproteinase-9. Diabetes Care. 2003; 26:3310–4.
Search in Google Scholar Back to article
Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation. 2005; 111:1448–54.
Search in Google Scholar Back to article
Ng KW, Allen ML, Desai A, Macrae D, Pathan N. Cardioprotective effects of insulin: how intensive insulin therapy may benefit cardiac surgery patients. Circulation. 2012; 125:721–8.
Search in Google Scholar Back to article
Chaudhuri A, Dandona P, Fonseca V. Cardiovascular benefits of exogenous insulin. J Clin Endocrinol Metab. 2012; 97:3079–91.
Search in Google Scholar Back to article
Dandona P, Aljada A, Mohanty P, Ghanim H, Hamouda W, Assian E, Ahmad S. Insulin inhibits intranuclear nuclear factor κB and stimulates IκB in mononuclear cells in obese subjects: evidence for an anti-inflammatory effect? J Clin Endocrinol Metab. 2001; 86:3257–65.
Search in Google Scholar Back to article
Singh SR, Ahmad F, Lal A, Yu C, Bai Z, Bennett H. Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis. Can Med Assoc J. 2009; 180:385–97.
Search in Google Scholar Back to article
Umpierrez GE, Jones S, Smiley D, Mulligan P, Keyler T, Temponi A, et al. Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009; 32:1164–9.
Search in Google Scholar Back to article
DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review. JAMA. 2003; 289:2254–64.
Search in Google Scholar Back to article
Owens DR. Insulin preparations with prolonged effect. Diabetes Technol Ther. 2011; 13:S5–14.
Search in Google Scholar Back to article
Kalra S, Gupta Y. Clinical use of insulin degludec: practical experience and pragmatic suggestions. N Am J Med Sci. 2015; 7:81–5.
Search in Google Scholar Back to article
Donner T. Insulin—pharmacology, therapeutic regimens and principles of intensive insulin therapy. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, et al., editors. Endotext [online]. 2010 [cited 2017 Jan 10]. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK278938/
Search in Google Scholar Back to article
Heise T, Pieber TR. Towards peakless, reproducible and long-acting insulins. An assessment of the basal analogues based on isoglycaemic clamp studies. Diabetes Obes Metab. 2007; 9:648–59.
Search in Google Scholar Back to article
Matteucci E, Giampietro O, Covolan V, Giustarini D, Fanti P, Rossi R. Insulin administration: present strategies and future directions for a noninvasive (possibly more physiological) delivery. Drug Des Devel Ther. 2015; 9:3109–18.
Search in Google Scholar Back to article
Umpierrez GE, Latif K, Stoever J, Cuervo R, Park L, Freire AX, Kitabchi AE. Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis. Am J Med. 2004; 117:291–6.
Search in Google Scholar Back to article
Vincent M, Nobecourt E. Treatment of diabetic ketoacidosis with subcutaneous insulin lispro: a review of the current evidence from clinical studies. Diabetes Metab. 2013; 39:299–305.
Search in Google Scholar Back to article
Boullu-Sanchis S, Ortega F, Chabrier G, Busch MS, Uhl C, Pinget M, Jeandidier N. Efficacy of short term continuous subcutaneous insulin lispro versus continuous intravenous regular insulin in poorly controlled, hospitalized, type 2 diabetic patients. Diabetes Metab. 2006; 32:350–7.
Search in Google Scholar Back to article
Joshi GP, Chung F, Vann MA, Ahmad S, Gan TJ, Goulson DT, et al. Society for ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesth Analg. 2010; 111:1378–7.
Search in Google Scholar Back to article
The American Diabetes Association. Standards of medical care in diabetes—2017: summary of revisions. Diabetes Care. 2017; 40:S4–5.
Search in Google Scholar Back to article
Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, et al. American Association of Clinical Endocrinologists and American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan-2015—executive summary. Endocr Pract. 2015; 21:1–87.
Search in Google Scholar Back to article
Owens DR, Jones MK, Hayes TM, Heding LG, Alberti KG, Home PD, Burrin JM. Comparative study of subcutaneous, intramuscular, and intravenous administration of human insulin. Lancet. 1981; 2:118–22.
Search in Google Scholar Back to article
Guerra SM, Kitabchi AE. Comparison of the effectiveness of various routes of insulin injection: insulin levels and glucose response in normal subjects. J Clin Endocrinol Metab. 1976; 42:869–74.
Search in Google Scholar Back to article
Evans CH, Lee J, Ruhlman MK. Optimal glucose management in the perioperative period. Surg Clin North Am. 2015; 95:337–54.
Search in Google Scholar Back to article
Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab. 2010; 95:4338–44.
Search in Google Scholar Back to article
Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012; 97:16–38.
Search in Google Scholar Back to article
Gosmanov AR, Umpierrez GE. Management of hyperglycemia during enteral and parenteral nutrition therapy. Curr Diab Rep. 2013; 13:155–62.
Search in Google Scholar Back to article
Carvalho G, Lattermann R, Codere-Maruyama T, Schricker T. Glucose and insulin administration while maintaining normoglycemia: the GIN concept. Minerva Anestesiol. 2013; 79:74–82.
Search in Google Scholar Back to article
Dagogo-Jack S, Alberti KGMM. Management of diabetes mellitus in surgical patients. Diabetes Spectr. 2002; 15:44–8.
Search in Google Scholar Back to article
Association of Anaesthetists of Great Britain and Ireland, Working party members:, Barker P, Creasey PE, Dhatariya K, Levy N, et al. Peri-operative management of the surgical patient with diabetes 2015. Anaesthesia. 2015; 70:1427–40.
Search in Google Scholar Back to article
Patient Safety Alert. ‘High-alert’ medications and patient safety. Int J Qual Health Care. 2001; 13:339–40.
Search in Google Scholar Back to article
Koczmara C, Jelincic V, Dueck C. Dangerous abbreviations: “U” can make a difference. Dynamics. 2005; 16:11–5.
Search in Google Scholar Back to article
Koczmara C, Hyland S, Jelincic V. High alert: preventing insulin errors. Dynamics. 2004; 15:10–1.
Search in Google Scholar Back to article
Barth E, Albuszies G, Baumgart K, Matejovic M, Wachter U, Vogt J, et al. Glucose metabolism and catecholamines. Crit Care Med. 2007; 35:S508–18.
Search in Google Scholar Back to article
Vanhorebeek I, Van den Berghe G. Diabetes of injury: novel insights. Endocrinol Metab Clin North Am. 2006; 35:859–72.
Search in Google Scholar Back to article
Thorell A, Efendic S, Gutniak M, Haggmark T, Ljungqvist O. Development of postoperative insulin resistance is associated with the magnitude of operation. Eur J Surg. 1993; 159:593–9.
Search in Google Scholar Back to article
Thorell A, Efendic S, Gutniak M, Haggmark T, Ljungqvist O. Insulin resistance after abdominal surgery. Br J Surg. 1994; 81:59–63.
Search in Google Scholar Back to article
Ellger B, Debaveye Y, Vanhorebeek I, Langouche L, Giulietti A, Van Etten E, et al. Survival benefits of intensive insulin therapy in critical illness: impact of maintaining normoglycemia versus glycemiaindependent actions of insulin. Diabetes. 2006; 55:1096–105.
Search in Google Scholar Back to article
Sato H, Hatzakorzian R, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T. High-dose insulin administration improves left ventricular function after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2011; 25:1086–91.
Search in Google Scholar Back to article
Albacker TB, Carvalho G, Schricker T, Lachapelle K. Myocardial protection during elective coronary artery bypass grafting using high-dose insulin therapy. Ann Thorac Surg. 2007; 84:1920–7.
Search in Google Scholar Back to article
Shim JK, Yang SY, Yoo YC, Yoo KJ, Kwak YL. Myocardial protection by glucose-insulin-potassium in acute coronary syndrome patients undergoing urgent multivessel off-pump coronary artery bypass surgery. Br J Anaesth. 2013; 110:47–53.
Search in Google Scholar Back to article
Howell NJ, Ashrafian H, Drury NE, Ranasinghe AM, Contractor H, Isackson H, et al. Glucose-insulin-potassium reduces the incidence of low cardiac output episodes after aortic valve replacement for aortic stenosis in patients with left ventricular hypertrophy: results from the hypertrophy, insulin, glucose, and electrolytes (HINGE) trial. Circulation. 2011; 123:170–7.
Search in Google Scholar Back to article
Demircan S, Yazici M, Diraman E, Demircan G, Kilicaslan F, Durna K, et al. The effect of glucose-insulin-potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention. Coron Artery Dis. 2008; 19:99–104.
Search in Google Scholar Back to article
Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2014; 7:255–64.
Search in Google Scholar Back to article
Amiel SA, Sherwin RS, Simonson DC, Tamborlane WV. Effect of intensive insulin therapy on glycemic thresholds for counterregulatory hormone release. Diabetes. 1988; 37:901–7.
Search in Google Scholar Back to article
Liamis G, Liberopoulos E, Barkas F, Elisaf M. Diabetes mellitus and electrolyte disorders. World J Clin Cases. 2014; 2:488–96.
Search in Google Scholar Back to article
Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009; 373:1798–807.
Search in Google Scholar Back to article
De Vries FEE, Gans SL, Solomkin JS, Allegranzi B, Egger M, Dellinger EP, Boermeester MA. Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection. Br J Surg. 2017; 104:e95–105.
Search in Google Scholar Back to article
Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010; 33:1783–8.
Search in Google Scholar Back to article
Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of perioperative glycemic control in general surgery: a report from the surgical care and outcomes assessment program. Ann Surg. 2013; 257:8–14.
Search in Google Scholar Back to article
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345:1359–67.
Search in Google Scholar Back to article
D’Alessandro C, Leprince P, Golmard JL, Ouattara A, Aubert S, Pavie A, et al. Strict glycemic control reduces EuroSCORE expected mortality in diabetic patients undergoing myocardial revascularization. J Thorac Cardiovasc Surg. 2007; 134:29–37.
Search in Google Scholar Back to article
Kirdemir P, Yildirim V, Kiris I, Gulmen S, Kuralay E, Ibrisim E, Ozal E. Does continuous insulin therapy reduce postoperative supraventricular tachycardia incidence after coronary artery bypass operations in diabetic patients? J Cardiothorac Vasc Anesth. 2008; 22:383–7.
Search in Google Scholar Back to article
Kotagal M, Symons RG, Hirsch IB, Umpierrez GE, Dellinger EP, Farrokhi ET, et al. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg. 2015; 261:97–103.
Search in Google Scholar Back to article
Buehler L, Fayfman M, Alexopoulos AS, Zhao L, Farrokhi F, Weaver J, et al. The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients. J Diabetes Complications. 2015; 29:1177–82.
Search in Google Scholar Back to article
Margonis GA, Amini N, Sasaki K, Kim Y, Merath K, Buettner S, et al. Perioperative hyperglycemia and postoperative outcomes in patients undergoing resection of colorectal liver metastases. J Gastrointest Surg. 2017; 21:228–37.
Search in Google Scholar Back to article
Kremers HM, Schleck CD, Lewallen EA, Larson DR, Van Wijnen AJ, Lewallen DG. Diabetes mellitus and hyperglycemia and the risk of aseptic loosening in total joint arthroplasty. J Arthroplasty. 2017; 32:s251–3.
Search in Google Scholar Back to article
Fisette A, Hassanain M, Metrakos P, Doi SA, Salman A, Schricker T, et al. High-dose insulin therapy reduces postoperative liver dysfunction and complications in liver resection patients through reduced apoptosis and altered inflammation. J Clin Endocrinol Metab. 2012; 97:217–26.
Search in Google Scholar Back to article
Hassanain M, Metrakos P, Fisette A, Doi SA, Schricker T, Lattermann R, et al. Randomized clinical trial of the impact of insulin therapy on liver function in patients undergoing major liver resection. Br J Surg. 2013; 100:610–8.
Search in Google Scholar Back to article
Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG. Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. Anesthesiology. 2010; 112:860–71.
Search in Google Scholar Back to article
Yoo S, Lee HJ, Lee H, Ryu HG. Association between perioperative hyperglycemia or glucose variability and postoperative acute kidney injury after liver transplantation: a retrospective observational study. Anesth Analg. 2017; 124:35–41.
Search in Google Scholar Back to article
Krinsley JS. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med. 2008; 36:3008–13.
Search in Google Scholar Back to article
Egi M, Bellomo R, Stachowski E, French CJ, Hart G. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006; 105:244–52.
Search in Google Scholar Back to article
Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, Colette C. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006; 295:1681–7.
Search in Google Scholar Back to article
Houlden R, Capes S, Clement M, Miller D. In-hospital management of diabetes. Can J Diabetes. 2013; 37:S77–81.
Search in Google Scholar Back to article
Dhatariya K, Levy N, Kilvert A, Watson B, Cousins D, Flanagan D, et al. NHS diabetes guideline for the perioperative management of the adult patient with diabetes. Diabet Med. 2012; 29:420–33.
Search in Google Scholar Back to article
Abdelmalak BB, Knittel J, Abdelmalak JB, Dalton JE, Christiansen E, Foss J, et al. Preoperative blood glucose concentrations and postoperative outcomes after elective non-cardiac surgery: an observational study. Br J Anaesth. 2014; 112:79–88.
Search in Google Scholar Back to article
Noordzij PG, Boersma E, Schreiner F, Kertai MD, Feringa HH, Dunkelgrun M, et al. Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur J Endocrinol. 2007; 156:137–42.
Search in Google Scholar Back to article
Abdelmalak B, Abdelmalak JB, Knittel J, Christiansen E, Mascha E, Zimmerman R, et al. The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study. Can J Anaesth. 2010; 57:1058–64.
Search in Google Scholar Back to article
Hatzakorzian R, Bui H, Carvalho G, Shan WL, Sidhu S, Schricker T. Fasting blood glucose levels in patients presenting for elective surgery. Nutrition. 2011; 27:298–301.
Search in Google Scholar Back to article
Krinsley JS. Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: six and one-half years experience at a university-affiliated community hospital. Semin Thorac Cardiovasc Surg. 2006; 18:317–25.
Search in Google Scholar Back to article
Lauruschkat AH, Arnrich B, Albert AA, Walter JA, Amann B, Rosendahl UP, et al. Prevalence and risks of undiagnosed diabetes mellitus in patients undergoing coronary artery bypass grafting. Circulation. 2005; 112:2397–402.
Search in Google Scholar Back to article
Koenig RJ, Peterson CM, Jones RL, Saudek C, Lehrman M, Cerami A. Correlation of glucose regulation and hemoglobin A_Ic in diabetes mellitus. N Engl J Med. 1976; 295:417–20.
Search in Google Scholar Back to article
Gustafsson UO, Thorell A, Soop M, Ljungqvist O, Nygren J. Haemoglobin A1c as a predictor of postoperative hyperglycaemia and complications after major colorectal surgery. Br J Surg. 2009; 96:1358–64.
Search in Google Scholar Back to article
Goh SNS, Yeoh E, Tan KY. Impact of perioperative hypoglycemia in subjects with diabetes undergoing colorectal surgery. Int J Colorectal Dis. 2017; 32:209–14.
Search in Google Scholar Back to article
Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, et al. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2008; 136:631–40.
Search in Google Scholar Back to article
O’Sullivan CJ, Hynes N, Mahendran B, Andrews EJ, Avalos G, Tawfik S, et al. Haemoglobin A1c (HbA1C) in non-diabetic and diabetic vascular patients. Is HbA1C an independent risk factor and predictor of adverse outcome? Eur J Vasc Endovasc Surg. 2006; 32:188–97.
Search in Google Scholar Back to article
Ljungqvist O, Nygren J, Thorell A. Insulin resistance and elective surgery. Surgery. 2000; 128:757–60.
Search in Google Scholar Back to article
Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999; 2:69–78.
Search in Google Scholar Back to article
National Guideline Centre (UK). Preoperative tests (update): routine preoperative tests for elective surgery. London: National Institute for Health and Care Excellence (UK); 2016.
Search in Google Scholar Back to article
Bock M, Johansson T, Fritsch G, Flamm M, Hansbauer B, Mann E, Sönnichsen A. The impact of preoperative testing for blood glucose concentration and haemoglobin A1c on mortality, changes in management and complications in noncardiac elective surgery: a systematic review. Eur J Anaesthesiol. 2015; 32:152–9.
Search in Google Scholar Back to article
Partridge H, Perkins B, Mathieu S, Nicholls A, Adeniji K. Clinical recommendations in the management of the patient with type 1 diabetes on insulin pump therapy in the perioperative period: a primer for the anaesthetist. Br J Anaesth. 2016; 116:18–26.
Search in Google Scholar Back to article
Sudhakaran S, Surani SR. Guidelines for perioperative management of the diabetic patient. Surg Res Pract. 2015; 2015:284063. 10.1155/2015/284063.
Open DOI Search in Google Scholar Back to article
Marks JB. Perioperative management of diabetes. Am Fam Physician. 2003; 67:93–100.
Search in Google Scholar Back to article
Schricker T, Lattermann R. Perioperative catabolism. Can J Anaesth. 2015; 62:182–93.
Search in Google Scholar Back to article
Sato H, Lattermann R, Carvalho G, Sato T, Metrakos P, Hassanain M, et al. Perioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing major liver resection. Anesth Analg. 2010; 110:1711–8.
Search in Google Scholar Back to article
Carvalho G, Moore A, Qizilbash B, Lachapelle K, Schricker T. Maintenance of normoglycemia during cardiac surgery. Anesth Analg. 2004; 99:319–24.
Search in Google Scholar Back to article
Carvalho G, Pelletier P, Albacker T, Lachapelle K, Joanisse DR, Hatzakorzian R, et al. Cardioprotective effects of glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing coronary artery bypass grafting. J Clin Endocrinol Metab. 2011; 96:1469–77.
Search in Google Scholar Back to article
Albacker T, Carvalho G, Schricker T, Lachapelle K. High-dose insulin therapy attenuates systemic inflammatory response in coronary artery bypass grafting patients. Ann Thorac Surg. 2008; 86:20–7.
Search in Google Scholar Back to article
Karon BS, Donato LJ, Larsen CM, Siebenaler LK, Wells AE, Wood-Wentz CM, et al. Accuracy of capillary and arterial whole blood glucose measurements using a glucose meter in patients under general anesthesia in the operating room. Anesthesiology. 2017; 127:466–74.
Search in Google Scholar Back to article
Karon BS, Meeusen JW, Bryant SC. Impact of glucose meter error on glycemic variability and time in target range during glycemic control after cardiovascular surgery. J Diabetes Sci Technol. 2016; 10:336–42.
Search in Google Scholar Back to article
Egi M, Bellomo R. Reducing glycemic variability in intensive care unit patients: a new therapeutic target? J Diabetes Sci Technol. 2009; 3:1302–8.
Search in Google Scholar Back to article
Sato H, Hosojima M, Ishikawa T, Aoki K, Okamoto T, Saito A, Tsuchida M. Glucose variability based in continuous glucose monitoring assessment is associated with postoperative complications after cardiovascular surgery. Ann Thorac Cardiovasc Surg. 2017; 23:239–47.
Search in Google Scholar Back to article
Gomez AM, Umpierrez GE. Continuous glucose monitoring in insulin-treated patients in non-ICU settings. J Diabetes Sci Technol. 2014; 8:930–6.
Search in Google Scholar Back to article
Donatelli F, Vavassori A, Bonfanti S, Parrella P, Lorini L, Fumagalli R, Carli F. Epidural anesthesia and analgesia decrease the postoperative incidence of insulin resistance in preoperative insulin-resistant subjects only. Anesth Analg. 2007; 104:1587–93.
Search in Google Scholar Back to article
Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007; 30:2181–6.
Search in Google Scholar Back to article

Perioperative insulin therapy

Abstract

Paradigm

My account