INTRAOPERATIVE GLYCEMIC CONTROL IN NON-INSULIN-DEPENDENT AND INSULIN-DEPENDENT DIABETES

We have compared intraoperative glycaemic control, insulin requirement s and metabolic and endocrine variables in 40 non-insulin-dependent pa tients (NIDDM) and 40 insulin-dependent diabetic patients (IDDM) under going general anaesthesia for elective procedures. Two i.v. insulin re gimens were used: continuous i.v. infusion (group A: 1.25 u. h(-1)) an d repeated i.v. boluses (10 u./2 h). Blood concentrations of glucose w ere measured every 15 min from just before induction of anaesthesia un til 2 h after surgery. Plasma lactate and pyruvate concentrations, ket one bodies, C-peptide and counterregulatory hormones were also measure d. Glycaemia did not differ significantly in the two types of diabetes , regardless of the insulin therapy used. The amounts of insulin admin istered were similar in NIDDM and IDDM. There was no significant diffe rence for other metabolic variables. Plasma concentrations of growth h ormone (GH) increased significantly during surgery, especially in IDDM patients, but this change did not alter intraoperative glycaemic cont rol. We conclude that mean glycaemic control, insulin requirements and development of ketone bodies in NIDDM and IDDM patients did not diffe r during the operative period, regardless of the insulin regimen used. Therefore, during the operative period, it is not necessary to modify the insulin regimen according to the type of diabetes. The consequenc es of increaed plasma GH concentrations on glycaemic control in IDDM p atients after operation are unknown.