Peri-operative management of glucose

It is generally agreed that it is important to control blood glucose levels during the peri-operative period. However, there have been controversies surrounding the appropriateness of each regimen, as well as ideal glucose targets during surgery. This review focuses on a simple and practical strategy to control glucose during surgery, and sets out simple guidelines on instituting an insulin infusion protocol. From the available evidence, a fasting plasma glucose < 90 mg/dl, postprandial glucose < 180 mg/dl and an HbA1c < 7% is ideal before elective surgery. The blood glucose must be maintained between 140 and 180 mg/dl during the operative period as well as during the intensive care unit (ICU stay). Sliding scales are inappropriate for in-hospital glucose control. A basal-bolus insulin regimen is ideal for hospitalised peri-operative subjects outside the ICU. In the ICU, it is best to use an insulin infusion protocol for glucose control. The ideal regimen should be individualised for each patient. The success of peri-operative glucose control requires teamwork between the various medical personnel involved in patient care.