The Rationale and the Strategies to Achieve Perioperative Glycaemic Control
Highlights
- hypoglycaemia leads to neuroglycopaenia with subsequent cognitive impairment, seizures, coma, and ultimately death. Neuroglycopaenic effects begin to occur at approximately 2.8 mmol litre−1 (View Highlight)
- Level at which studies show increased risk of complications>6 (View Highlight)
- Level at which the AAGBI and JBDS guidelines suggest optimization before elective surgery>8.5 (View Highlight)
- Hyperglycaemia is defined as a CBG greater than 6.0 mmol litre−1 (View Highlight)
- The Joint British Diabetes Societies (JBDS)8 and the Association of Anaesthetists of Great Britain and Ireland (AAGBI)9 have now defined hyperglycaemia in the perioperative period as a CBG >10.0 mmol litre−1, with a CBG of up 12.0 mmol litre−1 being acceptable. (View Highlight)
- Hypoglycaemia is defined as a CBG <4.0 mmol litre−1 (View Highlight)
- It is now recognized that the use of the VRIII may often cause hypoglycaemia; furthermore, this may be because the many scales previously promoted a target zone of 4–8 mmol litre−1, and there was no safety buffer zone between safe and dangerous use. Therefore, it is now advised that the scales be redesigned to promote all blood sugars to remain in the 6–10 mmol litre−1 zone (View Highlight)
- As the half-life of soluble insulin is approximately 5 min, within 30 min of stopping a VRIII there will be no appreciable functioning insulin. If the patient has T1DM, DKA will ensue. Therefore, in T1DM patients the VRIII must never be taken down until alternative s.c. insulin has been administered. (View Highlight)
- Continuous administration of substrate fluid with glucose to permit continuous administration of insulin is mandatory in starved patients with T1DM; however, this may not be the case in patients with T2DM. (View Highlight)
- Give s.c. rapid-acting analogue insulin. Assume that 1 unit will decrease blood glucose by 3 mmol litre−1 (View Highlight)
- Current advice by the JBDS and the AAGBI8,9 is that a CBG >12.0 mmol litre−1 should be treated. (View Highlight)