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Role of Insulin in Reducing Mortality in the Perioperative Period

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Reducing Mortality in the Perioperative Period

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Abstract

Hyperglycaemia is a frequently diagnosed metabolic abnormality in the inpatient setting, either related to the case of known diabetes, previously undiagnosed diabetes or as a result of the acute or exacerbation of presenting chronic illness [1, 2]. Stress hyperglycaemia may also be induced by medications including steroids, inotropic agents, immunosuppressants and nutritional support via the enteral or parenteral route [1, 2]. Preoperative glycaemic imbalance and perioperative elevations of blood glucose are directly associated with poor prognosis [1–4], including increase in mortality, decrease in cardiovascular event-free survival, increase in resource utilisation and decrease in quality of life. Hyperglycaemia significantly influences hospital morbidity, including increase in the risk of infections, renal failure, prolonged mechanical ventilation and anaemia requiring blood transfusions, which subsequently extends the length of hospital stay [1–4].

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Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland

    Łukasz J. Krzych MD, PhD

  2. 1st Department of Cardiology, University Hospital No. 7, Upper Silesia Medical Centre, Medical University of Silesia, Katowice, Poland

    Maciej T. Wybraniec MD

Authors
  1. Łukasz J. Krzych MD, PhD
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  2. Maciej T. Wybraniec MD
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Corresponding author

Correspondence to Łukasz J. Krzych MD, PhD .

Editor information

Editors and Affiliations

  1. Anestesia Rianimazione e Terapia Intensiva, Università Vita-Salute San Raffaele Ospedale San Raffaele, Milan, Italy

    Giovanni Landoni

  2. Anestesia Rianimazione e Terapia Intensiva, Università Vita-Salute San Raffaele Ospedale San Raffaele, Milan, Italy

    Laura Ruggeri

  3. Anestesia Rianimazione e Terapia Intensiva, Università Vita-Salute San Raffaele Ospedale San Raffaele, Milan, Italy

    Alberto Zangrillo

Summary Table

Summary Table

Clinical summary

Drugs

Indications

Cautions

Side effects

Dosage

Notes

Insulin in intravenous infusion (regular human insulin or short-acting analogue)

Perioperative management of hyperglycaemia in patients with diabetes type 1/2 and excessive intraoperative hyperglycaemia in patients without previous history of diabetes

Severe risk of hypoglycaemia and hypokalaemia

Hypoglycaemia

Initial insulin infusion of 0.5–1 IU/h, then 0.3 IU/h increments or decrements depending on blood glucose level

Target intraoperative blood glucose level is 140–180 mg/dL

Glucose level should be checked directly before surgery and every 1 h during and after the procedure

Hypokalaemia

Minor ambulatory procedures in diabetes type 2 can be performed without IV insulin

[K+] should be verified before and after the procedure

Allergic reactions

In patients with a well-controlled diabetes type 2 treated with diet or oral agents, IV insulin is not obligatory

Weight gain

Lipodystrophy

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Krzych, Ł.J., Wybraniec, M.T. (2017). Role of Insulin in Reducing Mortality in the Perioperative Period. In: Landoni, G., Ruggeri, L., Zangrillo, A. (eds) Reducing Mortality in the Perioperative Period. Springer, Cham. https://doi.org/10.1007/978-3-319-46696-5_12

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  • DOI: https://doi.org/10.1007/978-3-319-46696-5_12

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-46696-5

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