Test Your Knowledge Answer #436

In addition to patients who have type 1 diabetes, patients with other types of diabetes may also have insulin deficiency. Characteristics of patients with potentially severe insulin deficiency include a prior history of diabetic ketoacidosis, prior pancreatic surgery, severe pancreatic dysfunction, a history of an extended duration of diabetes and insulin use, or a history of metabolic instability. These patients are at very high risk for ketoacidosis, so insulin should not be withheld in these patients.Although insulin infusion is the preferred method of glycemic control during surgery because it offers the most flexibility, this option is not always available. Instead, patients are frequently asked to adjust their outpatient regimens in preparation for surgery. Insulin glargine is a basal insulin; therefore, the dosage is typically unchanged or reduced by 20% if a patient will not eat for the day. Patients who have fasting blood glucose below 80 mg/dL (4.44 mmol/L) or who snack frequently during the day typically need a small reduction in dosage when fasting. They frequently do not have the typical insulin use of 50% basal/50% bolus; instead, a larger percentage of their insulin is basal insulin. Patients who do not snack and do not take additional insulin typically do not require such a dosage reduction. Rapid-acting insulin analogues may be used to treat acute hyperglycemia but at a reduced dosage because the prandial component is not required while the patient is not eating. Patients taking neutral protamine Hagedorn (NPH) insulin typically halve their morning dosage because NPH insulin has both basal and prandial components. These adjustments are only general suggestions—changes must be individualized for each patient.

 

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