Interactive diabetes case 12: Perioperative management of a 67-year-old patient with type 2 diabetes who undergoes coronary artery bypass surgery – B3

ANSWER — Incorrect.

It is appropriate to address the transition to a basal dose of subcutaneous insulin as soon as possible when the decision is made to stop an intravenous insulin infusion and to begin the process of determining the insulin regimen that will be needed at the time of discharge from the hospital. It is also a good idea to plan for an overlap of the insulin infusion and the subcutaneous glargine to allow absorption of the glargine to occur.

The dose of glargine is reasonable, representing 80 percent of the estimated basal insulin requirement calculated from the intravenous insulin infusion rate when the patient is stable. In this instance, the infusion rate is 2 units an hour, or 48 units per 24 hours. Eighty percent of 48 units is approximately 38 units. However, the sliding scale as written is unlikely to have an impact on the patient's glucose levels. The scale starts at a blood glucose of 201 mg/dL (11.2 mmol/L) and at 2 units of aspart insulin.

Return to the previous choice 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 – A3".)