Insulin-dependent diabetes surgery

A 63-year-old white man with insulin-dependent diabetes and recent coronary artery bypass surgery developed diffuse muscle pain with generalized muscular weakness after taking amiodarone 1 g/day for 10 days then 200 mg/ day plus simvastatin 40 mg/day (37). He had a significant increase in creatine kinase activity, peaking at 40 392 U/l. 

A 45-year-old man with insulin-dependent diabetes associated with nephropathy, neuropathy, and retinopathy was given dextran 40 (25ml/hour) after orthopedic surgery (20). His urine output fell from 2 to 3 liters on postoperative day, 1 0 ml/day on day 2, and his creatinine clearance fell from 54 to 32ml/min-ute. There were many casts in the urine. Dextran was withdrawn, but his creatinine clearance fell to 12 ml/minute on day 5. On day 6 a large hematoma in the rectus sheath was drained, followed by plasmapheresis (to remove dextran) and hemodialysis. Over the next 24 hours, his urine output increased to 2.21/day... 

HONK coma occurs mostly in elderly, non-insulin dependent diabetics, and develops relatively slowly over days or weeks. The level of insulin is sufficient to prevent ketosis but does not prevent hyperglycacmia and osmotic diuresis. Precipitating factors include severe illness, dehydration, glucocorticoids, diuretics, parenteral nutrition, dialysis and surgery. Extremely high blood glucose levels (above 35 mmol/l. and usually above 50 mmol/l) accompany severe dehydration resulting in impaired consciousness. 

Treatment of insulin-dependent type 1 diabetes mellitus and non-insulin-dependent type 2 diabetes mellitus when diet or weight control has failed to maintain satisfactory blood glucose levels or in event of fever, infection, surgery, ortrauma, or severe endocrine, hepatic, or renal dysfunction emergency treatment of ketoacidosis (regular insulin) to... 

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