The American College of Endocrinology, in conjunction with the American Society of Anesthesiologists, published a position statement that outlines

these goals (4) A summary of these guidelines include the following !" Always maintain blood glucose below !#$ mg%d&" There is biochemical e'idence suggesting fa'ourable alterations in myocardial and s(eletal muscle metabolism, immune function, inflammation, and endothelial cell and platelet function with normoglycemia (4)*)" +" ,aintain blood glucose between #$)!!$ mg%d& in intensi'e care unit (-C.) patients" /an den 0erghe et al" (1) demonstrated a reduction in mortality in surgical -C. patients with a 2 day -C. stay with intensi'e insulin therapy, in which goal glucoses of !!$ mg%d& were maintained regardless of their diabetes history (#)" 3" A'oid oral hypoglycemic drugs unless patients are on a regular diet" 4ral hypoglycemic drugs do not maintain tight glycemic control" Although there are no randomi5ed controlled trials e'aluating oral drug use in surgical patients, the long halflife of these drugs ma(e titration in the face of changing clinical parameters difficult" 6urthermore, many of the oral drugs, (e"g", metformin and thia5olidinediones) do not decrease serum glucose but rather increase tissue sensiti'ity to insulin" 6urther, sulfonylureas use has been associated with prolonged hypoglycemia re7uiring continuing inter'entions especially in patients with hepatic, renal, and adrenal insufficiency" 4" 8ro'ide basal insulin in patients who are insulindeficient" -nsulin9 deficient diabetics should always ha'e basal insulin with either continuous -/ insulin or long9acting subcutaneous insulin" -n these patients, a sliding scale alone is insufficient" :ithholding basal insulin in insulin9deficient indi'iduals has reportedly resulted in an increase in serum glucose by 42 mg%d& per hour (;)" 2" Create and implement a hypoglycemia pre'ention and management protocol" Though patients may benefit from tight glucose control, the use of insulin poses the ris( for hypoglycemia perioperati'ely" The <oint Commission on Accreditation of =ealthcare 4rgani5ations (www"jcaho"org) considers insulin to be one of the fi'e high alert medications, since medication errors in'ol'ing insulin can ha'e catastrophic conse7uences" Caregi'ers using tight glucose control protocols must educate caregi'ers to recogni5e signs of hypoglycemia, understand the potential accuracy of finger9stic( measurements of glucose, and (now appropriate inter'entions"