Question 23

A 40 yo woman is scheduled to undergo total abdominal hysterectomy for a large leiomyomatous uterus. She has type 2 diabetes which is controlled with long and short-acting insulin. The best preoperative management to optimize perioperative glucose control on the day prior to surgery is:

Answer Choices:

Continue current insulin regimen

Decrease nighttime dose of insulin

Discontinue nighttime dose of insulin

Switch to short-acting sliding scale

Correct Answer:

Decrease nighttime dose of insulin

Explanation:

  • Goal in diabetes is to balance the risk of hypoglycemia with the known benefits in reduced morbidity and mortality with good glucose control

  • Current consensus guidelines recommend perioperative glycemic goals between 80 and 150 mg/dL.

  • In general, on the day of surgery, oral regimens for diabetes should be discontinued (secretagogues can cause hypoglycemia, sulfonylureas can increase the risk of MI and metformin has a theoretical risk of lactic acidosis). Instead, can use short-acting insulin if needed.

  • Patients on insulin should reduce nighttime dose on the night before surgery to prevent hypoglycemia while they are NPO.