MICU/SICU - why open heart patients have high blood sugar?

[telefloornurse]

i can't find it in the internet

a little help please

[MistyDawnRN06, BSN, RN]

i can't find it in the internet

a little help please

The open heart patients that I get post-op are on epinephrine drips and nipride drips. Both of these medications have to me mixed in D5W. So those patients that don't have a history of diabetes do need insulin coverage due to the extra sugar we're dumping in their systems. Beyond the meds, I think a big porption of hyperglycemia in post-op patients is the stress response.

I'm still a new grad, but I'm working in an SICU and we get all the post-op heart patients. That's my findings thus far.

[Kymmi]

The high glucoses post open heart surgery is due to a combination of factors. Patients who are not diabetic typically also develop higher blood sugars also. It is the body's response to stress, the drips that are used ie levophed and esp. epinephrine (although it is mixed in Dextrose the amount of dextrose actually received isnt that significant to raise sugars) however the drugs themselves will cause sugars.

The writer that wrote about controlling them quickly was absolutely correct because studies have shown that quick control of blood glucose levels make for a better outcome post surgery. I think most post open heart surgery programs now use some sort of IV insulin drip coverage immediately following surgery as opposed to in the past when q 4-6 hour accuchecks with sq sliding scale coverage was used.

[dfk, RN, CRNA]

yes.... stress is number one (IMHO).. of course, IDDM is right up there too... if i squeeze ur fingertip to get a drop of blood out, that too will increase the result.. remember, if it ain't coming out easily, check another site.. !!! NEVER lancet a calloused finger.. look for the soft skin... and anyone with a temp (and warm/hot skin) will bleed nicely for you... again... NEVER force the drop out !!!

[mummer43, BSN, RN]

Stress response, drips, and drugs. Epinephrine frequently causes hyperglycemia, as do some iv steroids commonly used for lung problems.

This is what causes it.

[dfk, RN, CRNA]

I wonder if you read the internet article correctly - generally, hyperglycemia increases fatty acid metabolism, and not vice versa?

Bottom line is it doesn't matter why the hyperglycemia, so much as that it is controlled quickly and strictly - there are a lot of data about worse outcomes with high sugars, regardless of prior diabetes.

i know this is an old thread, but this statement, if i am reading correctly, is wrong.

FFA metabolism occurs when blood sugars are low, unless the patient is IDDM.

insulin responds to hyperglycemia, which turns off FFA metabolism.

[emersushea]

I was told by a cardiothoracic surgeon on our unit that intraoperatively when the heart is disturbed, the body releases glucose stores. He described it as a sudden surge of glucose. Which makes sense, your body thinks its under attack and it needs the energy (via glucose) to flee to safety. Any stressor can raise blood sugar, and in this instance the stressor is having your chest ripped open...pleasant huh? Thats why patients undergoing open heart procedures like CABGs are placed on insulin drips to prevent hyperglycemia for a variety of reasons.

[sundowners2]

This is how I teach my pt.'s: different types of stress have different effects of BG. With good stress (e.g., exercise), we metabolize circulating glucose and BG goes down. With bad stress (e.g., tissue trauma/ inflammation, surgery, infection, emotional stress), our natural stress response converts glycogen to glucose, increasing BG, and thus the hyperglycemia and need for insulin therapy.

This gets to be an almost automated response from me bc one of the most frequent questions I get from post-op's is, "But I'm NOT diabetic! I've never needed insulin before! Why now?"

[sarahrain]

Stress response mainly if he or she is not diabetes.

[Spatialized]

At least in the patient population we deal with, there is a pretty high incidence of undiagnosed diabetes and pre-diabetes. That's why the surgeons always check a HbgA1C pre-op. Add that to the stress situation of surgery and voila' you have hyperglycemia.

Cheers,

Tom