Metabolic changes in the non-insulin-dependent diabetic undergoing minor surgery: effect of glucose-insulin-potassium...

We have compared the metabolic response to minor surgery in the non-insulin dependent diabetic patient with that in the non-diabetic, using transurethral surgery under general anaesthesia as a model. Preoperative blood glucose and 3-hydroxybutyrate concentrations were higher in the diabetic patients, but the response to surgery did not differ. The postoperative cortisol response was lower in the diabetic patients. Glucose insulin potassium infusion (GIK) resulted in lower plasma nonesterified fatty acid, and blood 3-hydroxybutyrate and glycerol concentrations, with markedly higher serum insulin levels compared to patients managed with a 'no insulin' regimen. Blood glucose however was not significantly different except at 2 h postoperatively. Blood metabolite and serum insulin concentrations in the diabetic patients were closer to those in non-diabetic patients in the group not given insulin, than in those given GIK. Rather than rendering the diabetic patient the same as the non-diabetic, GIK produces a further abnormal state which is probably of little benefit. We conclude that there is no indication for the use of insulin in the well or moderately well-controlled non-insulin dependent diabetic patient undergoing minor surgery, provided that glucose containing fluids are not given.