Perioperative management of non-diabetic patients with hyperglycaemia (stress-induced hyperglycaemia)

© Springer International Publishing Switzerland 2016. Abstract Stress-induced hyperglycaemia (SIH) is defined as an acute and transient elevation in blood glucose during illness in patients who do not have diabetes and in whom hyperglycaemia will presumably subside after discharge. Surgical patients with SIH have increased risks of surgical site infections, cardiovascular morbidity and total mortality. However, the causal relationship between SIH and poor outcome is still a matter of debate. Although previous studies have advocated strict control of hyperglycaemia to diminish SIH-related morbidity, recent studies have supported the use of a less strict approach, with the targeting of glucose levels to above 140 mg/dl (7.8 mmol/l) to minimize the risk of hypoglycaemic events. Treatment of SIH is based on the use of intravenous insulin therapy with variable rate infusion, adjusted according to the results of blood glucose monitoring during the operative period, with a switch to subcutaneous insulin as soon as possible during the recovery phase. Patients with perioperative SIH should be tested for previously undiagnosed diabetes using the HbA1c test and treated accordingly. Patients without diabetes should be followed by their primary care team because they probably have an elevated risk of developing diabetes in the future.