An Institutional Peri-operative Intravenous Insulin Infusion Algorithm: Evaluation and Recommendations

The purpose of this retrospective medical record analysis was to examine our non-cardiac surgery insulin algorithm for efficacy, safety and provider adherence. The sample included 132 hyperglycemic patients (standard group) that were placed on intravenous insulin infusions. Nineteen patients using insulin pumps at home that had been converted for surgery to intravenous infusions were separately studied. Efficacy, safety and adherence definitions were developed and data was extrapolated to address the research purpose.  Captured data did not reflect any incidences of blood glucose (BG) measurements <50 mg/dl; two BG were however <70 mg/dl in the standard group. In the standard group, 73% of patients achieved BG of 100-179 mg/dl and an 85% mean proportion of subsequent time within range (MPST) through the remaining peri-operative period. Algorithm adherence metrics were 54-58%. Lower time-weighted average BG (190 vs 206 mg/dl; p=.03) was achieved where providers adhered to the intravenous insulin maintenance table >67% of the time. In insulin pump patients, MPST was 81% after conversion to intravenous infusions. Increased algorithm adherence was associated with improved peri-operative glycemic control. In insulin pump patients, successful conversion was attributed to glycemic nurse practitioner collaboration and algorithm reference. Algorithm modifications are proposed to increase adherence and safety.      

Associations of exercise-induced hormone profiles and gains in strength and hypertrophy in a large cohort after weight training

The purpose of this study was to investigate associations between acute exercise-induced hormone responses and adaptations to high intensity resistance training in a large cohort (n = 56) of young men. Acute post-exercise serum growth hormone (GH), free testosterone (fT), insulin-like growth factor (IGF-1) and cortisol responses were determined following an acute intense leg resistance exercise routine at the midpoint of a 12-week resistance exercise training study. Acute hormonal responses were correlated with gains in lean body mass (LBM), muscle fibre cross-sectional area (CSA) and leg press strength. There were no significant correlations between the exercise-induced elevations (area under the curve—AUC) of GH, fT and IGF-1 and gains in LBM or leg press strength. Significant correlations were found for cortisol, usually assumed to be a hormone indicative of catabolic drive, AUC with change in LBM (r = 0.29, P < 0.05) and type II fibre CSA (r = 0.35, P < 0.01) as well as GH AUC and gain in fibre area (type I: r = 0.36, P = 0.006; type II: r = 0.28, P = 0.04, but not lean mass). No correlations with strength were observed. We report that the acute exercise-induced systemic hormonal responses of cortisol and GH are weakly correlated with resistance training-induced changes in fibre CSA and LBM (cortisol only), but not with changes in strength