Our experience of controlling diabetes in the peri-operative period of patients who underwent cardiac surgery

Sliding-scale insulin used for blood glucose control: a meta-analysis of randomized controlled trials

“…Of these studies, one study evaluated approaches to glucose management for diabetic patients who had undergone cardiopulmonary bypass; 4 were study protocols, 13 investigated the efficacy and safety of using the insulin regimens other than sliding scale; 4 studied the effects of the RISS, but no glycemic control outcomes provided; and 77 compared the outcomes of RISS and non-sliding-scale regimens, but were not randomized. Thus, the final number of eligible studies was 11 [4][5][6][7][8][9][10][25][26][27][28].…”

“…Eight studies evaluated the effects of blood glucose management involving the use of either the RISS or non-sliding-scale regimens [4][5][6][7][8][9]27,28]. The RISS regimen was uniformly referred to as the subcutaneous injection of regular insulin according to the blood glucose levels of the patient in all studies.…”

“…However, the non-sliding-scale regimens varied in these studies. One study used continuous intravenous insulin infusion [4], two studies used a closed-loop artificial pancreas on glycemic control [5,6], one study used 0.3 U/kg glargine once daily as initial dose and adjusted the dose based on blood glucose levels [27], and four studies used basal-bolus insulin regimens [7][8][9]28]. The basal-bolus regimen consisted of neutral protamine hagedorn (NPH) insulin once daily at night and regular insulin 3 times per day before meals (initial total daily dose of 0.25 U/kg) in one study [7], and glargine once daily and glulisine before meals (initial total daily dose of 0.4-0.5 U/kg) in the rest 3 studies [8,9,28].…”

“…For patients who are not critically ill, premeal glucose is recommended to be maintained at less than 140 mg/dL, and the random glucose level should be maintained at less than 180 mg/dL [3]. Numerous insulin regimens have been developed for managing inpatient hyperglycemia, including intravenous insulin infusion, the automatic closed-loop infusion of regular insulin or glucose (artificial pancreas system), multiple daily subcutaneous insulin that consists of basal and bolus or preprandial components, and sliding-scale insulin with or without regularly scheduled insulin [4][5][6][7][8][9][10]. However, controlling glucose levels within the target range without inducing any hypoglycemic events remains difficult because an acute disease state or stress, duration of diabetes, various medications used during hospitalization, and nutritional intake may influence the blood glucose levels of inpatients [11][12][13][14].…”

Perioperative Control of Blood Glucose

“…In this approach, 100IU insulin in 100mL 0.09% NaCl is infused together with 100-200mL/hour 5% Dextrose in water (D 5 W). There are small studies showing the effectiveness of this approach (32,33). Recently, variable rate intravenous insulin infusion is used to control blood glucose in the perioperative setting.…”