A Simple Glucose Insulin Regimen for Perioperative Blood Glucose Control: The Vellore Regimen

Christian Medical College & Hospital, Ludhiana, Punjab, India
Anesthesia & Analgesia (Impact Factor: 3.47). 09/2004; 99(2):598-602, table of contents. DOI: 10.1213/01.ANE.0000122824.21065.CA
Source: PubMed


In this study, we sought a simple, easily implemented method of intraoperative control of blood glucose in diabetic patients in a large multispecialty teaching hospital. The Vellore regimen, which offers the advantages of a combined glucose insulin and variable rate infusion was evaluated. For every 1 to 50-mg/dL increase in blood glucose concentration more than 100 mg/dL, 1 U of insulin was added to the injection port of a 100-mL measured volume set containing 5% dextrose in water. Hourly monitoring of blood glucose was performed. The blood glucose control was compared with the different existing techniques followed in the hospital in 204 randomized patients: 98 in the study and 106 in the control group. The study group had a mean +/- sd blood glucose value of 156 +/- 36 mg/dL, and the control group's value was 189 +/- 63 mg/dL (P = 0.003). The percentage of patients who were poorly controlled (outside 100 to 200-mg/dL range) decreased from 51% to 28% (no patient less than 60 mg/dL) with this regimen as compared with the control group in which it increased from 49% to 72% (10 patients less than 60 mg/dL) (P = 0.0013). We conclude that the Vellore regimen is simple, effective, and safe for intraoperative blood glucose control.

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    • "Chaney et al. [32] reported that 40% of patients in the “tight control” group required treatment for postoperative hypoglycemia. On the other hand several studies using a modified insulin clamp technique and various modifications of insulin infusion regimens reveal the safe and effective use of this treatment in cardiac surgical patients [33,34,35,36]. "
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    ABSTRACT: During the past few years, it has become evident that metabolic control is a major determinant of postoperative outcomes, not only for diabetic patients but for all patients undergoing surgery. In cardiac and vascular surgery, myocardial ischemia is a common challenge and the management of hyperglycemia should be part of the strategy aimed at optimizing cardiac protection during these types of surgery, since performed in high risk patients. Little informations are available on the relation between glucose substrate and the type of anesthesia and few studies have been performed on glucose metabolism in the perioperative risk assessment as well as on intraoperative and post surgical management of hyperglycemia in patients submitted to cardiac and vascular surgery. Evidence exists that even slight increased in glycemia are detrimental for patients (diabetic and non) elective for cardiac and vascular surgery, though the precise details of the timing of insulin therapy, the desired target serum glucose level, and the duration of therapy are so far to be completely elucidated. Anesthestiologists can therefore affect outcome by simply preserving a normal blood glucose concentration initiating in the operating room. The challenge to optimize glucose control should begin during preoperative evaluation.
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    ABSTRACT: Several recent studies have established a correlation between tight glucose control and decreased perioperative morbidity and mortality in surgical and critically ill patients. We hypothesize that a progressive increase in delay in implementing insulin infusion rate changes would result in a progressively longer time to target glucose level and a progressive decrease in the percentage of time spent within a target glucose range. We formulate a mathematical model of glucose-insulin regulation, validate it with patient data, and use it to conclude that progressive delays in implementing insulin infusion rates result in a progressively longer time to target and poorer glycemic control in all three simulated patient types (Normal, Type 1 and Type 2 Diabetes Mellitus).
    No preview · Article · Feb 2005 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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