About this article
Article Category: Review article
Published Online: Oct 10, 2018
Page range: 395 - 404
DOI: https://doi.org/10.1515/abm-2018-0014
Keywords
© 2017 Prangmalee Leurcharusmee et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Recommendations for glycemic control during perioperative period
| Perioperative care | Intensive care | |
|---|---|---|
| ADA (2017) [ | 80–180 mg/dL | 140–180 mg/dL with insulin therapy, generally <180 mg/dL |
| AACE/ACE (2015) [ | <140 mg/dL for premeal glucose <180 mg/dL for random glucose | 140–180 mg/dL |
| AAGBI (2015) [ | 108–180 mg/dL | Not available |
| CDA (2013) [ | 90–144 mg/dL for premeal glucose <180 mg/dL for random glucose | 144–180 mg/dL |
| JBDS (2012) [ | 108–180 mg/dL 72–216 mg/dL is acceptable | Not available |
| SAMBA (2010) [ | 90–130 mg/dL for premeal glucose <180 mg/dL for random glucose | Not available |
Assessment points for effects of insulin
| Effect | Potential case | Assessment | |
|---|---|---|---|
| Clinical | Investigation | ||
| Glucose lowering | Fasting | Sweating | Blood glucose |
| Use of oral hypoglycemic | Tachycardia | ||
| Renal and hepatic impairment | Tremors | ||
| Alcohol consumption | Convulsion | ||
| Coma | |||
| Hypokalemia | Mineralocorticoid excess (Cushing syndrome, primary | Fatigue | Serum/urine electrolytes |
| hyperaldosteronism, use of corticosteroids) | Weakness | Electrocardiogram | |
| Parenteral or enteral nutrition | Arrhythmia | ||
| Thiazide or loop diuretics use | Polyuria | ||
| Hypophosphatemia | Hyperparathyroidism Parenteral or enteral nutrition | Weakness (diplopia, dysphagia) Confusion | Serum electrolyte |
| Protein anabolism | – | – | Serum albumin |
| Nitrogen balance | |||
| Antilipolysis | – | – | Serum-free fatty acids |
| Acid–base balance | |||
| Vasodilation | Concomitant use of vasodilators | Increased blood flow to skeletal | Blood pressure |
| myocardial, cerebral tissues | Vascular resistance | ||
| Positive inotropic | – | – | Cardiac output |
Pharmacokinetics, role of treatment, and dosing of insulin preparations [18, 19, 20, 21]
| Insulin type | Onset | Peak | Effective duration | Role of treatment | Dosing |
|---|---|---|---|---|---|
| Rapid acting | 5–15 min | 30–90 min | 2–5 h | Bolus | Postprandial |
| Aspart (NovoRapid) | 5–15 min | 30–90 min | 2–5 h | Bolus | Postprandial |
| Lispro (Humalog) | |||||
| Short acting | 30–60 min | 2–3 h | 5–8 h | Bolus | Postprandial |
| Regular (Humulin R) | |||||
| Intermediate acting | 1–2 h | 4–10 h | 10–16 h | Basal | Twice daily |
| NPH (Humulin N) | 1–2 h | 4–12 h | 12–18 h | Basal | Twice daily |
| Lente (Monotard) | |||||
| Long acting | 2–3 h | 4–8 h | 8–24 h | Basal | Twice daily |
| Ultralente (Humulin U) | 2–4 h | No peak | 20–24 h | Basal | Once daily |
| Glargine (Lantus) | 3–4 h | 6–8 h | Up to 20–24 h | Basal | Once/twice daily |
| Detemir (Levemir) | 30–90 min | No peak | Up to 42 h | Basal | Once daily |
| Degludec |