Interactive diabetes case 12: Perioperative management of a 67-year-old patient with type 2 diabetes who undergoes coronary artery bypass surgery – B4

ANSWER — Correct.

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. The aspart correction doses begin with 4 units, approximately 10 percent of the basal dose, at a blood glucose of 141 mg/dL (7.8 mmol/L) and progress appropriately.

Further discussion of the management of this patient is located elsewhere. (See "Interactive diabetes case 12: Perioperative management of a 67-year-old patient with type 2 diabetes who undergoes coronary artery bypass surgery – Comment".)