Managing diabetic surgical patients with glucose-free saline and insulin

Sixty-one people with glucose intolerance received a glucose-free solution during surgery. If their blood glucose levels rose above 200 mg/dl, they were given insulin intravenously, according to a rate algorithm reported elsewhere. None of the cases judged to be borderline required any insulin during their operations. Ten percent of the diabetics who were being treated with diet alone, and 40% of those using hypoglycemic agents or insulin, did require insulin. Insulin was delivered at an average rate of 2.1 +/- 5.2 U/h and controlled the serum glucose levels within a range of 132 +/- 32 mg/dl. This suggests that half of all diabetics undergoing surgery require only a glucose-free solution for fluid replacement to maintain their glucose levels below 200 mg/dl, and that insulin infusion is an appropriate means to control hyperglycemia during surgery.