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Aldo A. Rossini, MD; John W. Hare, MD

Arch Surg. 1976;111(9):945-949.

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)

Author Affiliations
From the Elliot P. Joslin Research Laboratory (Drs Rossini and Hare), the Department of Medicine (Dr Rossini), Harvard Medical School, the Department of Medicine (Dr Hare), New England Deaconess Hospital, and the Peter Bent Brigham Hospital (Dr Rossini), Boston.

Footnotes
Accepted for publication May 20, 1976.

Reprint requests to Joslin Clinic, 15 Joslin Rd, Boston, MA 02215 (Dr Rossini).

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