Comparison of two methods of i.v. insulin administration in the diabetic patient during the perioperative period

Abstract

We have examined the effects of two types of insulin therapy (continuous i.v. infusion (group A: 1.25 u. h-1) and direct i.v. bolus administration of 10 u. every 2 h (group B: 10 u./2 h)) on the metabolic and endocrine responses to surgery in 60 adult diabetic patients undergoing general anaesthesia for elective procedures. Blood glucose concentrations were measured every 15 min from just before induction of anaesthesia until 2 h after surgery. Plasma ketone bodies, lactate, pyruvate, insulin, C-peptide and counter-regulatory hormone concentrations were measured also. Blood glucose concentrations were comparable in both groups, except at 60 min, because of fluctuating blood glucose concentrations in group B. In each group, one patient became hyperglycaemic. One case of hypoglycaemia occurred in group B. There were no statistically significant differences for the other data except for C-peptide. We conclude that, during the operative period, the administration of a direct i.v. bolus of insulin 10 u. every 2 h is a simple and effective method to control blood glucose concentrations; the method can be used when an insulin infusion pump is not available.

Comparison of two insulin protocols for diabetic dogs undergoing cataract surgery

“…Therefore, diabetic dogs undergoing a more major surgery might be expected to require higher insulin doses than those tested in this study. In fact, due to the difficulties in predicting the insulin requirements of diabetic patients undergoing different types of surgery in human medicine, the intravenous administration of insulin and glucose together, coupled with a close monitoring of blood glucose concentrations, is oftentimes the method of choice for regulating blood glucose concentrations in the peri‐operative period (Eldridge & Sear 1996; Lanier 1991; Raucoules‐Aime et al. 1994a,b).…”

Administration of insulin during surgery

“…However, we are not in agreement with all the comments made, particularly those concerning the risk of hypoglycaemia associated with the bolus method of administration of insulin. It is correct that the number of patients included in our study (n = 60) does not allow us to be confident that the bolus method is not associated with a greater risk of hypoglycaemia [1]. However, Walts and colleagues [2] reported a 5% incidence of hypoglycaemia with a bolus method similar to that found when continuous infusion was used (5-10 % ) [3][4][5].…”

“…Sir,-I was interested to read the paper by Raucoules-Aime and colleagues [1] on perioperative blood glucose control in diabetics using bolus administration of insulin in place of a continuous infusion. I do not agree with the authors' conclusion that bolus administration is comparable in safety and efficacy with an infusion.…”

Use of i.v. insulin in well-controlled non-insulin-dependent diabetics undergoing major surgery

“…shortacting insulin (Actrapid HM, Novo, France), started just before induction of anaesthesia. In group B (n : 20), patients were given insulin as a continuous infusion (1.25 u. h 91 ) by an electrically driven syringe (40 u./31 ml 0.9 % saline (1.25 u. : 1 ml)) [10]; patients in group C (n : 20) were given insulin 10 u. by direct i.v. bolus injection every 2 h [11].…”

“…Plasma ketone bodies (acetoacetate, ␤-hydroxybutyrate), lactate, pyruvate, C-peptide and counter-regulatory hormones (catecholamines, cortisol, glucagon, growth hormone) were measured in venous samples (S) taken just before induction (S1), during surgery (S2 : 30 min after the beginning of cholecystectomy; 60 min for gastrectomy, bowel resection, hip replacement and spinal surgery), and immediately after completion of surgery and tracheal extubation (S3). Details of the assays have been published previously [10]. The following variables were recorded: capillary glucose concentrations; treatment failure (defined as blood glucose concentration :3.3 mmol litre 91 or 916.5 mmol litre 91 ); total amount of insulin and number of additional boluses given; plasma acetoacetate and ␤-hydroxybutyrate : acetoacetate ratios at S1, S2, S3; plasma lactate, pyruvate concentrations and lactate : pyruvate ratios at S1, S2, S3; plasma C-peptide and counter-regulatory hormone concentrations at S1, S2, S3.…”