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April 17, 1981

Control of Glucose Level

JAMA. 1981;245(15):1527. doi:10.1001/jama.1981.03310400013011

To the Editor.—  The algorithm presented by Woodruff et al (1980;244:166) to prevent perioperative hyperglycemia may be less simple than the innocent reader realizes at first glance. The authors refer briefly to this in their final paragraph. For example, I am concerned with the casual reference to the two subjects whose serum glucose level declined to dangerously low levels during surgery. Granted they were young and their coronary arteries apparently patent; however, the potentially lethal combination of hypoglycemia, hypoxemia, and certain drugs or metabolites in the bloodstream is well known.1In addition, I am intrigued by the risk-benefit consideration during selection of subject 3. The primary goal of the authors is adequate control of glucose levels, thereby preventing complications. One of the fringe benefits of good control is cost containment. The algorithm may serve that purpose, but oversimplification can readily defeat it.2