Insulin-dependent diabetes during the peri-operative period. An assessment of continuous glucose-insulin-potassium infusion, and traditional treatment

Abstract

Twenty seven insulin-dependent diabetics, and six non-diabetic subjects undergoing elective surgery have been studied. Twelve diabetics received continuous glucose-insulin-potassium (GIK) infusion for at least 4 hours after surgery terminated. Six diabetic patients having morning surgery received a proportion of their morning insulin dose with intravenous glucose (25 g) before surgery and the remaining five operated on in the afternoon received their morning insulin with breakfast. Non-GIK groups were combined and compared with GIK. Postoperative diabetic treatment was the same in both groups. Plasma glucose changes were studied in all patients and other metabolites whenever possible. Mean pre-operative glucose, non-esterfied fatty acid, and 3-hydroxybutyrate concentrations were similar in GIK and non-GIK groups. Four hours postoperatively plasma glucose, and 3-hydroxybutyrate values were lower in the GIK group than in the non GIK group (p less than 0.05) as were mean plasma non-esterfied fatty acid levels. Plasma glucose concentration was also lower in GIK subjects at 72 hours postoperatively (p less than 0.01). At other times measured metabolic variables were similar in both GIK and non GIK groups.