In 38 cases of esophageal cancer with glucose intolerance, we studied the administration of insulin during and after surgery and whether glucose-containing fluids should be infused from the beginning of surgery. On the operation day, conventional insulin injection or oral hypoglycemic agents were omitted, and the blood glucose levels were measured every 30-60 minutes during surgery, continuous intravenous insulin infusion (CIVII) being started when the blood glucose level exceeded 200 mg/dl. CIVII was carried out during surgery in all of the cases given glucose infusion from the beginning of surgery (G (+) group), and in 70% of the cases without glucose infusion at the beginning of surgery (G (-) group). As a rule, CIVII was changed to continuous subcutaneous insulin infusion (CSII) on the second day after the operation.
The results obtained were as follows:
(1) In the G (+) group, the effect of insulin in the early postoperative period was significantly higher than that in the G (-) group. There was no statistically significant difference between the two groups in plasma free insulin, free fatty acid, lactate and urea-N. However, the levels of plasma freee fatty acid and lactate were remarkably elevated during surgery in the G (-) group, indicating that metabolic abnormality was greater in the G (-) group. Therefore, in cases requiring long-duration surgery, such as that for esophageal cancer, it is necessary to administer glucosecontaining fluids and to control blood glucose with insulin from the beginning of surgery.
(2) Insulin treatment by CSII following CIVII was a simple, safe and effective way to control blood glucose in postoperative cases receiving intravenous hyperalimentation, in which glucose administration was increased stepwise.
(3) The amount of glucose infused was about 350 g per day after the third postoperative day, and blood glucose was controlled by CSII at a rate of less than 2 units per hour. Even in cases with mild glucose intolerance, 0. 5-4 unit per hour was required to control blood glucose.