Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which diabetes medication should not be omitted for a patient who is fasting in preparation for surgery?

1. Metformin

2. Sulfonylurea

3. Short acting insulin

4. Basal insulin

The correct answer is: Basal insulin

Basal insulin is often considered essential and should not be omitted for patients who are fasting in preparation for surgery for several reasons. Basal insulin is designed to provide a steady release of insulin throughout the day and night, helping to maintain baseline blood glucose levels. This steady coverage is crucial, especially for individuals with type 1 diabetes or those with type 2 diabetes who require insulin for adequate glycemic control. Omitting basal insulin in a fasting patient can lead to significant hyperglycemia, which increases the risk of complications during and after surgery, such as infection, poor wound healing, and other adverse outcomes related to elevated blood glucose levels. Additionally, uncontrolled blood glucose levels can complicate the surgical procedure itself and recovery. In contrast, metformin may be withheld due to concerns about the risk of lactic acidosis and the potential for transient renal impairment during surgery. Sulfonylureas can cause hypoglycemia, particularly in fasting patients, so they may also be skipped to avoid this risk. Short-acting insulin usually is adjusted according to the surgical plan and the patient's blood glucose readings, and may not always be necessary if the patient is not eating normally. However, basal insulin plays a pivotal role in maintaining stable and safe blood glucose levels regardless of