Interactive diabetes case 12: Perioperative management of a 67-year-old patient with type 2 diabetes who undergoes coronary artery bypass surgery – A4

ANSWER — Incorrect.

It is appropriate to conclude that the patient's diabetes was not adequately managed before admission on full doses of glipizide and metformin and to anticipate that the patient will need a basal insulin regimen at the time of discharge from the hospital. However, in a patient in the intensive care unit (ICU), the insulin requirement may change rapidly and dramatically. An intermediate-acting basal insulin (such as NPH) or a long-acting agent (such as glargine) does not provide sufficient flexibility to respond to changing insulin requirements.

Intravenous insulin allows rapid adjustments in insulin dose. Also, the hourly intravenous insulin infusion rate can be used to estimate the patient's 24-hour subcutaneous insulin requirement once the patient is stabilized and the insulin requirement is stable. This information can be used to choose the basal subcutaneous insulin dose at the time of transition from the intravenous to the subcutaneous route. The modest dose of NPH chosen is unlikely to approximate the patient's basal insulin requirement, based on the patient's size.

Return to the beginning to try again. (See "Interactive diabetes case 12: Perioperative management of a 67-year-old patient with type 2 diabetes who undergoes coronary artery bypass surgery".)