Background :
@EN The aim of diabetes control during surgery must be to attain at least the same outcome in terms of morbidity and mortality as in the nondiabetic patients. This goal is best achieved by controlling the metabolic status of the patients. A
combined
glucose-insulin-potassium (GIK) infusion has been proposed as a convenient and effective way of obtaining good glycemic control during operation. We performed a pospective study to assess the effectiveness of GIK based on a modified Alberti's
protocol
on blood glucose control during operating in Korean NIDDM patients undergoing major surgery.
@ES Method :
@EN We studied prospectively 41 diabetes (NIDDM-DM) who received major operation at our hospital. Pre-operatively they were placed on insulin therapy and blood glucose was controlled with the mean level of 100 ㎎% to 200㎎%. During and after
surgery,
diabetes was controlled with GIK infusion according to a modified Alberti's protocol. The initial insulin content in GIK was varied according to preoperative insulin dose; 8 units of insulin in 10% dextrose 500 ml when pre-operative daily
subcutaneous
insulin dose was less than 20 units, 12 units when pre-operative dose from 20 units to 39 units and 16 units when pre-operative dose 40 units or more. When insulin requirement was not known pre-operatively, we started GIK with 12 units of
insulin.
And
the insulin content was increased by 4 units in case of severe infection, chronic liver disease or steroid treatment, and decreased by 4 units in case of renal failure. Also potassium was supplied in GIK based on the protocol for the prevention
of
post-operative electrolytes disturbances. Then the insulin content of GIK infusion was adjusted in steps of 4U/500ml to maintain the blood glucose in the range of 100㎎% to 200㎎%.
@ES Results :
@EN The acceptable control on the day of operation (defined as mean blood glucose 90-200㎎% without hypoglycemia) was achieved in 34 patients (82.9%). Six of 7 failures were attributed to incorrect implementation of the protocol. While the
initial
content of insulin was adequate in 48.8% of the patients, 39.0% required a higher, 12.2% a lower content. The insulin requirements had statistically significant correlation with pre-operative insulin doses(r=0.53, p<0.001), but no relationship
with
BMI.
The frequency of insulin content changes in GIK was 0.68±0.76 times during the mean infusion of 34 hours. 46.3% of the patients required no change, 41.5% required one time and 9.8% required 2 times. In 97.6% of the patients the changes were 2
times or
less. Plasma sodium concentration fell statistically significantly, but potassium did not. But clinically significant hyponatremia and hypokalemia did not occur.
@ES Conclusion :
@EN We managed successfully the diabetes during surgery in Korean NIDDM patients with GIK infusion based on a modified Alberti's protocol. Most of failures of the GIK regimen were due to deviation from the protocol. We suggest the GIK infusion
regimen
described here be suitable for the management of Korean NIDDM patients undergoing major surgery, and successful use of GIK infusion depend on accurate monitoring of blood glucose with prompt and appropriate changes in therapy.
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