How to control the blood glucose level in the surgical diabetic patient
A. A. Rossini and J. W. Hare
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 contrainvents 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.
