Interactive diabetes case 12: Perioperative management of a 67-year-old patient with type 2 diabetes who undergoes coronary artery bypass surgery – A1

ANSWER — Incorrect.

You see the patient on rounds early the next morning. The patient has had a difficult night. He was intermittently hypotensive and is currently receiving pressors, including levarterenol. The glucose level has risen to 429 mg/dL (23.8 mmol/L).

The insulin requirement may change rapidly and dramatically for patients in the intensive care unit (ICU) setting. An insulin sliding scale does not provide sufficient flexibility to respond to rapidly changing insulin requirements; intravenous insulin infusion is necessary to achieve this flexibility. In addition, a sliding scale insulin regimen is unlikely to provide enough insulin to control this patient's hyperglycemia. Patients in the ICU may develop acute insulin resistance, which compounds the probable chronic insulin resistance in this patient.

The hourly intravenous insulin infusion rate can be used to estimate the patient's basal 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 to use following the cessation of the intravenous insulin infusion.

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".)