USE OF IV INSULIN IN WELL-CONTROLLED NON-INSULIN-DEPENDENT DIABETICS UNDERGOING MAJOR SURGERY

We conducted a randomized, prospective study to assess the effect of i .v. insulin on blood glucose control, development of ketone bodies and hormonal changes in 60 well-controlled, non-insulin-dependent diabeti cs (NIDDM) undergoing major surgery. In group A, patients were given o nly 0.9% saline; in group B, patients were given insulin as a continuo us i.v, infusion (1.25 u. h(-1)); in group C, patients were given insu lin 10 u. i.v. boluses every 2 h. Patients in all three groups were gi ven insulin 5 u. when their intraoperative blood glucose concentration increased to greater than 11.1 mmol litre(-1). Blood glucose concentr ations were measured every 15 min, from just before induction of anaes thesia to 2 h after surgery. Plasma lactate, pyruvate, ketone body, C- peptide and counter-regulatory hormone concentrations were also measur ed. Blood glucose concentrations in the three groups did not differ si gnificantly. There was a mild-to-moderate increase in plasma ketone bo dy concentrations in group A, but without any deleterious consequences . Plasma C-peptide concentrations decreased significantly in groups B and C, especially in patients given bolus injections of insulin. Plasm a growth hormone concentrations also increased significantly in group B and C patients. This study indicated that the ''no insulin-no glucos e'' regimen was a simple, effective way to control blood glucose in we ll-controlled NIDDM patients, provided blood glucose was measured freq uently and insulin used appropriately.