Difficult perioperative glucose management in a type 2 diabetic patient with anti-insulin antibody undergoing laparoscopic partial liver resection

A 50-year-old man with type 2 diabetes mellitus was scheduled for laparoscopic partial liver resection. Six months prior to the surgery, he developed frequent hypoglycemic attacks and was diagnosed as anti-insulin antibody positive. The operation was performed under general anesthesia with epidural anesthesia Intermittent and continuous insulin administration was required during liver resection due to persistent hyperglycemia After termination of the liver resection, the patient exhibited uncontrolled hypo- and hyperglycemia and recovery from anesthesia was delayed due to severe hypoglycemia He recovered immediately after 40% glucose administration. However, frequent glucose administration was required for two hours after transfer to the ICU due to hypoglycemia It should be born in mind that preoperative poor glucose control might be caused by anti-insulin antibodies and lead to difficult perioperative glucose management.