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Although patients 1 and 2 became mildly and briefly hypoglycemic (nadir of serum glucose, 54 and 48 mg/dL, respectively), we readily detected, corrected, and modified our protocol to avoid this problem in the next six patients. Infusion of insulin requires careful blood glucose monitoring as we stressed in our article. Patient 3 was severely hyperglycemic before surgery (264 mg/dL). Furthermore, it is well known that surgical and anesthetic stress may elevate serum glucose, a phenomenon avoided in patient 3 by insulin infusion.Finally, we warn those who seek normoglycemia perioperatively to be alert to the need for higher insulin infusion than recommended in our article for the diabetic who has infection or who is receiving high-dose corticosteroids or other forms of stress adding to that of general anesthesia and surgery.
Lewis SB. Control of Glucose Level-Reply. JAMA. 1981;245(15):1527. doi:10.1001/jama.1981.03310400013012