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Open Access

Blood glucose control during cardiac surgery: an evaluation of a fixed versus a variable insulin regime

  • A Vohra1,
  • A Chan1 and
  • N Odom1
Critical Care20059(Suppl 1):P379

https://doi.org/10.1186/cc3442

Published: 7 March 2005

Keywords

SugarBlood GlucoseEmergency MedicineHypoBlood Sugar

Introduction

Intensive insulin therapy (blood glucose < 6.1 mmol/l) may reduce mortality after cardiac surgery (by 42%) [1]. An effective regime would keep blood glucose < 6 mmol/l for 80% of the time; < 8 for 90% of the time and <12 for 99% of the time, and no hypos (< 3.0).

Method

Ninety elective heart surgery patients were recruited, and randomly allocated a 'Fixed' regimen (F) (Table 1) or a 'Variable' regimen (V) (Table 2) (n = 45). Blood sugars were recorded 1–2 hourly postoperatively for 48 hours. In each patient the mean and standard deviation were calculated. Episodes of hypoglycaemia (< 3 mmol/l), and mild (6.1–8.0), moderate (8.1–12) or severe (>12) hyperglycaemia were identified.
Table 1

(abstract P379)

Blood sugar (mmol/l)

Infusion rate (IU/hour)

Additional bolus (units)

< 4.0

0

0

4.1–6.9

1

0

7.0–8.9

2

0

9.0–11.9

3

5

>12

4

10

Table 2

(abstract P379)

Blood sugar (mmol/l)

Start rate (IU/hour)

Sugar falling > 2/hour

Sugar fall 0.5–2/hour

Sugar stable

Sugar rising > 0.5/hour

> 9.1

4

No change

No change

Increase by 50%

Double rate

6.6–9.0

2

Decrease by 30%

No change

Increase by 50%

Increase by 50%

5.1–6.5

1

Decrease by 50%

Decrease by 30%

No change

Increase by 50%

3.0–5.0

0

Decrease by 80%

Decrease by 50%

Decrease by 30%

No change

Results and conclusion

The variable better controlled blood glucose (V = 6.5 ± 0.74; F = 7.0 ± 0.90) (P = 0.004) especially in patients with a high BMI (> 25) (Fig. 1). There were more hypos in F (n = 4) than V (n = 1). Glucose < 6 mmol/l was found for 33% of the time in F, 48% in V; < 8 mmol/l for 75% in F and 82% in V; <12 mmol/l for 99% in F and 99% in V.
Figure 1
Figure 1

(abstract P379)

Authors’ Affiliations

(1)
Manchester Royal Infirmary, Manchester, UK

References

  1. Van den Berghe G, et al.: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001, 345: 1359-1367. 10.1056/NEJMoa011300PubMedView ArticleGoogle Scholar

Copyright

© BioMed Central Ltd 2005

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