 I want to take a minute or two and just look at the evidence for glucose control in the perioperative period. We're going to give these patients insulin in the perioperative period. Why do we do so? What is the history of the research into this? Now the history is a bit checkered. First of all we thought it's a normal response to have an increased glucose level postoperative. And indeed that is so. Glucose levels do go up postoperative and there's physiological reasons for this. It cannot always just be left to chance though. A patient who's diabetic cannot just be left to have their glucose be totally uncontrolled. You are going to run into cases of morbidity, even mortality if that is so. Then research came along and looked at very tight control of glucose levels. We really tried to keep it below 110 milligrams per deciliter. Now multiplied by 0.0555 that gives you about 6.1 millimoles per liter. Very tight control and big research was done and it really showed a decrease in morbidity and mortality. Then randomized trials started coming out to show that perhaps is not really the truth and you can actually increase morbidity and mortality by such very tight control. And why was that so? Why did this discrepancy in the research? Well the first research really was not randomized and it really involved putting together a very good resources and taking care of these patients. So nurses well trained and they really put effort into treating and monitoring those patients to keep that glucose levels very tightly controlled as I said below 110 but also avoiding hypoglycemia. But that doesn't work in just normal circumstances. When trials, when patients were randomized under normal settings it was shown that there are a lot of incidences of hypoglycemia and that is just as important and it's actually a trend towards increased morbidity and mortality specifically due to other things as well but specifically due to the episodes of hypoglycemia. So today we stand in a situation where we really just try to control the glucose. We really try to keep it below a hundred and eighteen milligrams per deciliter. That's about 10 millimoles per liter. As long as we can keep it below that you will have better outcomes than either just leaving it be which really is not on or doing that very tight control of keeping it below a hundred and ten.