American Board of Internal Medicine (ABIM) Certification Practice Exam

According to clinical guidelines, how should long-acting insulin be managed on the day of surgery?

1. Administer the same dose as usual

2. Reduce the dose by half

3. Discontinue long-acting insulin

4. Switch to a short-acting insulin regimen

The correct answer is: Administer the same dose as usual

Insulin management on the day of surgery is crucial for maintaining glycemic control, especially in diabetic patients. Administering the same dose of long-acting insulin as usual is consistent with guidelines that emphasize the importance of avoiding hyperglycemia, which can increase the risk of surgical complications. Maintaining the same long-acting insulin dosage helps ensure there is an adequate baseline level of insulin to manage glucose levels in the body, especially since patients may not be eating normally due to fasting before surgery. While the patient's diet and activity levels will change on the surgery day, it is generally advised that the long-acting insulin not be altered excessively, as doing so may lead to instability in blood glucose levels. In practice, careful monitoring throughout the perioperative period is necessary, and adjustments can be made based on blood glucose readings and the patient's response to both the surgery and any input from the surgical team. Thus, administering the same dose aligns with the goal of maintaining consistent insulin levels and avoiding drastic changes that may lead to hyperglycemia or hypoglycemia.