Test Your Knowledge #536: A 56-year-old man with a history of diabetes secondary to chronic pancreatitis...
A 56-year-old man with a history of diabetes secondary to chronic pancreatitis with exocrine insufficiency is scheduled for intestinal resection because of colon cancer. He usually takes insulin glargine 30 U at night and insulin lispro at meals based on a correction dose (typical total daily insulin dose, 45 to 50 U).
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He has three to four snacks daily and does not use additional insulin. His typical fasting blood sugar is 74 to 100 mg/dL (4.11 to 5.55 mmol/L). His surgery is scheduled for tomorrow morning. He will arrive for preoperative evaluation directly from home and will not eat breakfast. The anesthesia team is not planning to infuse insulin during surgery.
Which of the following is the appropriate insulin adjustment, if any, in preparation for surgery?
A. Make no insulin adjustment.
B. Withhold all insulin.
C. Administer the usual dosage of insulin glargine and withhold insulin lispro in the morning.
D. Decrease the insulin glargine dosage by 20% and withhold insulin lispro in the morning.
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