Abstract
We report the successful use of intermittently scanned continuous glucose monitoring (isCGM) for blood glucose control during general anesthesia in a patient with type 1 diabetes. The patient was an 82-year-old woman (146 cm, 40 kg). At the age of 72 years, she began receiving bisphosphonates suitable for patients at risk for osteoporosis. She was diagnosed as having medication-related osteonecrosis of the jaw (MRONJ) and was scheduled to undergo a mandibular zonal resection under general anesthesia. The patient had type 1 diabetes mellitus, which was being managed with diet and insulin therapy. An isCGM sensor was placed on the left upper arm the day before surgery, and blood glucose control monitoring was performed perioperatively. The anesthesia was rapidly induced. The patient’s blood glucose level was measured using isCGM every 30 min beginning immediately after anesthesia induction. At 1 hour and 30 minutes after anesthesia induction, the patient’s blood glucose level increased to 206 mg/dL ; rapid acting insulin (2 UI) was administered subcutaneously and a 5% glucose infusion was started. The blood glucose level then decreased and remained at 190 mg/dL. Two hours and 30 minutes later, the patient’s blood glucose level once again increased to 204 mg/dL ; insulin (2 UI) was again injected subcutaneously. Thereafter, her blood glucose level remained at around 150 mg/dL until the end of surgery. After 4 hours and 15 minutes of treatment and 5 hours and 17 minutes of anesthesia, her blood glucose level was 126 mg/dL at the end of the procedure. This report describes a patient with type 1 diabetes mellitus who was monitored intraoperatively using isCGM. isCGM enables blood glucose trends to be monitored during enforced periods of fasting before and after surgery, allowing insulin to be administered promptly and preventing persistent hyperglycemia intraoperatively.
