Perioperative Management of Patients with Diabetes Mellitus

Y.P. Malyshev1, I.B. Zabolotskih1, K.M. Lebedinskii2, M.I. Neymark3, P.V. Dunts4

1FGBOU HE «Kuban State Medical University» Ministry of Health of the Russian Federation, Krasnodar

2FGBOU HE «Northwest State Medical University named I.I. Mechnikov» Ministry of Health of the Russian Federation, Saint-Petersburg

3FGBOU HE «Altai State Medical University» Ministry of Health of the Russian Federation, Barnaul

4FGBOU HE «Vladivostok State Medical University» Ministry of Health of the Russian Federation, Vladivostok

For correspondence: Malyshev Yuri Pavlovich — Ph.D., Professor, Department of Anesthesiology, Intensive Care and Transfusion FPC and PPP Medical University, «Kuban State Medical University» Ministry of Health of the Russian Federation, Krasnodar; e-mail: malyshevyp@mail.ru

For citation: Malyshev YP, Zabolotskikh IB, Lebedinskii KM, Neumark MI, Dunts PV. Perioperative Management of Patients with Diabetes Mellitus. Intensive Care Herald. 2016;4:41–51.


The article summarizes current understanding of the endocrine disorders caused by diabetes mellitus. Preoperative evaluation and assessment of patients with concomitant diabetes mellitus before anaesthesia are presented. Key points include preoperative period optimization, intraoperative management, prevention of urgent diabetes complications, blood glucose correction for urgent and elective surgery.

Keywords: diabetes mellitus, diagnosis, management of the patient, anesthesia, intensive care, perioperative

Received: 10.08.2016


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Indirect Calorimetry for Evaluation of Glucose and Lipid Metabolism in Surgical Patients on Total Parenteral Nutrition: a Pilot Study

A.I. Yaroshetskiy1, 2, S.O. Vasilieva2, N.A. Rezepov2, I.Y. Lapshina1, B.R. Gelfand1

1Pirogov Russian National Research Medical University, Moscow

2Moscow City Hospital № 67, Moscow

For correspondence: Yaroshetskiy Andrey — Head of Anesthesiology and Critical Care Department in Pirogov Russian National Research Medical University, Research Institution for Clinical Surgery Division, Moscow; e-mail: dr.intensivist@gmail.com

For citation: Yaroshetskiy AI, Vasilieva SO, Rezepov NA, Lapshina IY, Gelfand BR. Indirect Calorimetry for Evaluation of Glucose and Lipid Metabolism in Surgical Patients on Total Parenteral Nutrition: a Pilot Study. Intensive Care Herald. 2016;4:12–18.


Methods of nutrient metabolism evaluation in parenteral nutrition neither validated nor published. Aim of the study was estimation of predictive value of indirect calorimetry for insulin resistance before beginning of parenteral nutrition (PN) and evaluation of nutrient assimilation during PN. Methods. We include 22 patients after abdominal surgery on total PN by «three-in-one» system under glucose control. Before start of PN we calculated resting energy expenditure (REE) by Harris—Benedict (HB) equation and measured exhaled carbon dioxide per minute (VCO2), oxygen consumption (VO2), respiratory quotient (RQ) and REE by «CCM Express» metabolograph. After 3 hours of PN we repeated measurements of VCO2, VO2 and RQ. Results. REE by HB was 1606 (1438–2020) kcal/day but REE calculated had wider range [1913 (1208–2536)] (p=1.0). REE didn’t changed significantly after 3 hours of PN [1913 (1208–2536) vs. 1956 (1374–2532), p = 0.655]. RQ increased from 0.78 (0.69–0.83) till 0.88 (0.83–0.91) (p = 0.012). In diabetes mellitus subgroup of patients (n = 4) REE measured was significantly higher than HB REE (2547 (2331–2940) vs. 1834 (1571–2022), p = 0.046). Maximal glucose level during PN and insulin dose differed significantly in diabetes mellitus patients and non-diabetes patients [14.8 (13.1–15.4) vs. 10.6 (9.1–11.5), p = 0.020 and 190 (116–210) vs. 48 (15–82), p = 0.018, respectively]. In patients with RQ less than 0.7 [0.65 (0.64–0.69)] before start of PN (n = 7) assimilation of nutrients was unpredictable — RQ at 3 hours after start of PN had wide range 0.86 (0.73–0.91) (p = 0.025). We found strong correlation between RQ before start of PN and insulin dose during PN (rho = –0.729, p = 0.005). Conclusion. RQ measurement before PN may be a simple tool for insulin resistance estimation before start of PN and probably should lead to change in composition of PN and/or PN infusion rate.

Keywords: indirect calorimetry, insulin resistance, diabetes mellitus, respiratory quotient, energy expenditure

Received: 20.10.2016


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