8/13/2019 ACE-ASA Conjunction on Perioperative Blood Glucose
Control
1/1
The American College of Endocrinology, in conjunction with
theAmerican Society of Anesthesiologists, published a
positionstatement that outlines these goals (4) A summary of
theseguidelines include the following!" Always maintain blood
glucose below !#$ mg%d&" There is
biochemical e'idence suggesting fa'ourable alterations
inmyocardial and seletal muscle metabolism, immune
function,inflammation, and endothelial cell and platelet function
withnormoglycemia (4*)"
+" aintain blood glucose between #$!!$ mg%d& in intensi'e
careunit (-C.) patients" /an den 0erghe et al" (1) demonstrated
areduction in mortality in surgical -C. patients with a 2 day
-C.stay with intensi'e insulin therapy, in which goal glucoses of
!!$mg%d& were maintained regardless of their diabetes history
(#)"
3" A'oid oral hypoglycemic drugs unless patients are on a
regulardiet" ral hypoglycemic drugs do not maintain tight
glycemiccontrol" Although there are no randomi5ed controlled
trialse'aluating oral drug use in surgical patients, the long
halflife ofthese drugs mae titration in the face of changing
clinicalparameters difficult" 6urthermore, many of the oral drugs,
(e"g",metformin and thia5olidinediones) do not decrease
serumglucose but rather increase tissue sensiti'ity to insulin"
6urther,sulfonylureas use has been associated with
prolongedhypoglycemia re7uiring continuing inter'entions especially
inpatients with hepatic, renal, and adrenal insufficiency"
4" 8ro'ide basal insulin in patients who are insulindeficient"
-nsulin9
deficient diabetics should always ha'e basal insulin with
eithercontinuous -/ insulin or long9acting subcutaneous insulin"
-nthese patients, a sliding scale alone is insufficient"
:ithholdingbasal insulin in insulin9deficient indi'iduals has
reportedlyresulted in an increase in serum glucose by 42 mg%d&
per hour(;)"
2" Create and implement a hypoglycemia pre'ention andmanagement
protocol" Though patients may benefit from tightglucose control,
the use of insulin poses the ris forhypoglycemia perioperati'ely"
The
