Simplified Transition Algorithm from Intravenous to Subcutaneous Insulin in Nondiabetic Cardiac Surgery Patients with Stress Hyperglycemia

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1237-P ◽  
Author(s):  
SAUMETH CARDONA ◽  
RODOLFO J. GALINDO ◽  
KATERINA G. TSEGKA ◽  
MARIA A. URRUTIA ◽  
PRIYATHAMA VELLANKI ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Subcutaneous Insulin ◽  
Stress Hyperglycemia

scholarly journals Diabetes and Stress Hyperglycemia in the Intensive Care Unit: Outcomes After Cardiac Surgery

2012 ◽  
Vol 40 (2) ◽  
pp. 22-29 ◽  
Author(s):  
Roma Y. Gianchandani ◽  
Nazanene H. Esfandiari ◽  
Jonathan W. Haft ◽  
Richard L. Prager ◽  
Rodica Pop-Busui
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Stress Hyperglycemia

scholarly journals Intraoperative hyperglycemic stress response and tissue perfusion in cardiac surgery

2021 ◽  
Author(s):  
Aslı Demir ◽  
EDA BALCI ◽  
Hülya Yiğit Özay ◽  
MELİKE BAHÇECİTAPAR
Keyword(s):  
Cardiac Surgery ◽  
Tissue Oxygenation ◽  
Central Venous Oxygen Saturation ◽  
Tissue Perfusion ◽  
Extraction Rate ◽  
Oxygen Extraction ◽  
Diabetic Patients ◽  
Central Venous ◽  
Stress Hyperglycemia ◽  
Venous Oxygen Saturation

Background and aim of the study Approximately 30% of patients undergoing cardiac surgery have a history of diabetes and 60-80% of patients without diabetes have stress hyperglycemia. We examined patients undergoing cardiac surgery to determine the presence of stress hyperglycemia and its relationship to tissue perfusion. Methods Hemodynamic parameters, central venous oxygen saturation, lactate,oxygen delivery and consumption, oxygen extraction rate were analyzed at four intraoperative time points. Results The stress-induced hyperglycemic response during cardiac surgery was more severe in patients without diabetes. When focusing on the oxygen extraction rate in terms of tissue oxygenation, diabetic patients had 1.22 times higher and significant oxygen extraction rate than non-diabetic patients. Conclusions Although lactate values were slightly higher and central venous oxygen saturation were slightly lower in the diabetic group, considering the fact that oxygen extraction rate reflects the total outcome of small changes in all these parameters, we can emphasize the conclusion that diabetic patients undergoing cardiac surgery have greater tissue oxygen demand/supply imbalance compared to non-diabetic patients. In our study, this tissue oxygenation defect in diabetic patients was not found to be directly correlated with blood glucose levels. Perhaps, even if the disease is under control, the negative effects of diabetes on all systems have accumulated and led to such a result.

Glycemic Control After Cardiac Surgery

2020 ◽  
pp. 37-46
Author(s):  
Casey Shelley ◽  
Katherine Palmieri
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Surgery ◽  
Glycosylated Hemoglobin ◽  
Perioperative Period ◽  
Postoperative Management ◽  
Undiagnosed Diabetes ◽  
Stress Hyperglycemia ◽  
Glucose Levels ◽  
History Of ◽  
Guidelines And Recommendations

This chapter focuses on hyperglycemia after cardiac surgery, which is an independent predictor of morbidity and mortality, regardless of a history of diabetes. Acute hyperglycemia is common in the cardiac surgical perioperative period. Although many hyperglycemic patients undergoing cardiac surgery carry a preexisting diagnosis of diabetes mellitus, a significant portion will have either undiagnosed diabetes or insulin resistance. Other cardiac surgical patients may be non-diabetic but hyperglycemic due to the stress response related to surgery. This “stress hyperglycemia” is generally defined as a transient increase in blood glucose levels that develops during illness in a non-diabetic patient. A preadmission glycosylated hemoglobin (HbA1c) level measurement is helpful in distinguishing patients with stress hyperglycemia from those with undiagnosed diabetes mellitus and thus guide postoperative management. Patients with elevated HbA1c levels may need further interventions in order to optimize perioperative glycemic management pre-, intra-, and postoperatively. The chapter then details the Society of Thoracic Surgeons clinical practice guidelines and recommendations concerning perioperative glucose control.

Converting Continuous Insulin Infusion to Subcutaneous Insulin Glargine After Cardiac Surgery Using Percentage-Based Versus Weight-Based Dosing: A Pilot Trial

2013 ◽  
Vol 47 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Kevin M Silinskie ◽  
Ronald Kirshner ◽  
Mindee S Hite
Keyword(s):  
Cardiac Surgery ◽  
Blood Glucose ◽  
Insulin Glargine ◽  
Insulin Infusion ◽  
Insulin Dose ◽  
Pilot Trial ◽  
Blood Glucose Monitoring ◽  
Target Range ◽  
Subcutaneous Insulin ◽  
Continuous Insulin Infusion

BACKGROUND Most studies report using percentage of total daily insulin (TDI) for converting therapy from continuous insulin infusion to subcutaneous insulin in cardiac surgery patients. Few studies have evaluated the efficacy of using body weight to calculate the basal insulin dose. OBJECTIVE To compare the efficacy and safety of dosing insulin glargine by weight versus percentage of TDI in cardiac surgery patients transitioning from continuous insulin infusion to subcutaneous insulin. METHODS We conducted a prospective, randomized, open-label, pilot study. Study patients who had a preoperative weight less than 100 kg and were receiving at least 6 hours of a continuous insulin infusion were randomized to receive either 50% of their TDI requirement or 0.5 units/kg of glargine as a one-time dose 2 hours before stopping the continuous insulin infusion. All patients were administered subcutaneous corrective insulin. Blood glucose monitoring occurred before each meal, at bedtime, and with morning laboratory tests for 24 hours after administration of the glargine dose. RESULTS A total of 200 blood glucose measurements were performed in each group. The percentage of blood glucose measurements in target range (80–140 mg/dL) was similar between the weight-based group and the percentage-based group (66% vs 64%, p = 0.75). Median blood glucose after transition was 120 mg/dL (interquartile range [IQR] 99–147) in the weight-based group compared to 127 mg/dL (IQR 107–149; p = 0.03) in the percentage-based group. The median glargine dose was higher in the weight-based group (41 units; IQR 36–44) than in the weight-based group (24 units; IQR 14–30, p < 0.001). The rate of hypoglycemia (blood glucose <60 mg/dL) was 2.5% in each group. CONCLUSIONS In this small cohort, dosing insulin glargine by weight proved to be safe, but larger scale studies are needed before adopting weight-based dosing in this patient population.

Blood-volume studies in cardiac-surgery patients

JAMA ◽  
1966 ◽  
Vol 195 (5) ◽  
pp. 356-361 ◽  
Author(s):  
J. B. McClenahan
Keyword(s):  
Cardiac Surgery ◽  
Blood Volume
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