For last week’s practice question, we quizzed participants on the best action for a safe surgery. 51% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Question:

PZ is having elective surgery in the morning. Diabetes medications include 20 units glargine (Semglee) at hs, metformin BID and empagliflozin (Jardiance).

According to 2023 ADA Standards, what are the best actions for a safe surgery?

Answer Choices:

1. Give 15 units hs glargine, hold am oral meds, keep intraoperative glucose between 100-180.
2. Give 10 units hs glargine and am metformin, hold empagliflozin and use sliding scale as needed.
3. Give 20 units glargine, hold oral meds, get A1C less than 7% within 3 months before surgery.
4. Hold all oral meds for 3 days, given 50% of basal insulin and maintain glucose 80-140 intraoperatively.

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Getting to the Best Answer

Answer 1 is correct. 50.87% chose this answer, “Give 15 units hs glargine, hold am oral meds, keep intraoperative glucose between 100-180.” YES, GREAT JOB! The ADA Standard 16 on Hospitalization has been updated with new perioperative glucose goals and preop medication adjustments. To prevent intraoperative hypoglycemia, the glucose goal was increased to 100-180. In addition, they recommend reducing basal insulin by 20-25% the night before surgery and holding all oral meds the morning of surgery. SGLT-2s are held for 3-4 days before surgery to decrease risk of DKA in the perioperative period. In this vignette, we reduced PZ’s basal insulin from 20 units to 15 units (25% decrease) and held all oral meds the morning of surgery. In addition, the 2023 Standards recommend achieving an A1C less than 8% before elective surgeries. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.

Answer 2 is incorrect. 14.35% of you chose this answer, “Give 10 units hs glargine and am metformin, hold empagliflozin and use sliding scale as needed.” This is answer is close and partly correct, because it recommends holding the oral medications. However, the first part of the answer is incorrect since a basal insulin reduction of 50% is too aggressive. People release lots of counterregulatory hormones during surgery, so they still need at least 75% of their usual basal insulin dose to prevent intraoperative hyperglycemia. If the person uses NPH basal insulin, they would need to reduce the evening dose by 50%. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.

Answer 3 is incorrect. 15.73% of respondents chose this answer, “Give 20 units glargine, hold oral meds, get A1C less than 7% within 3 months before surgery.” This is answer is close and partly correct, because it recommends holding the oral medications. However, the first part of the answer is incorrect since the basal insulin needs to be reduced by 20-25% to prevent intraoperative hypoglycemia. In addition, the 2023 Standards recommend achieving an A1C less than 8% (not 7%) before elective surgeries. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.

Finally, Answer 4 is incorrect. 19.06% chose this answer, “Hold all oral meds for 3 days, given 50% of basal insulin and maintain glucose 80-140 intraoperatively.” This entire answer is incorrect for the following reasons. Oral meds are held the day of surgery, except for SGLT2i’s, which are held for 3-4 days pre-op. As far as basal insulin, the ADA guidelines recommend giving 75-80% of usual dose, except for NPH insulin, which is reduced by 50%. Lastly, the intraoperative glucose target is 100 -180. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.

Thank you so much for reading this “Rationale of the Week”.

We invite you to join Coach Beverly on May 30, 2023 – Hospital and Hyperglycemia 1.5 CEs

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Want to learn more about this question? Enroll in our

Level 2 | ADA Standards of Care CE Course | 2.0 CEs

2023 Update is Recorded & Ready to Watch!

This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2023 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for healthcare professionals involved in diabetes care and education.

Objectives:

1. List significant changes and updates to the 2023 ADA Standards of Medical Care.
2. State 3 updates on new blood pressure and lipid goals.
3. Identify 5 key elements of the position statement.
4. Discuss how to apply the Standards in the clinical setting and in preparation for exam success.

Intended Audience:  This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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Preparing for Diabetes Certification Exam? Enroll in our Level 3 – Boot Camp 2023 Updates

Level 3 | DiabetesEd Specialist Boot Camp | 12+ CEs

Can’t join all the sessions live? No problem. Your registration guarantees you access to the recorded lectures for a full year.

This bundle is specifically designed for healthcare professionals who are studying for the Board Certified in Advanced Diabetes Management (BC-ADM) or the Certified Diabetes Care and Education Specialist (CDCES) certification exam.

Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.

2023 Webinar Updates

1. Recorded & Ready to Watch – Class 1 – Diabetes – Not Just Hyperglycemia 1.75 CEs
2. February 9, 2023 – Class 2 – Standards of Care & Cardiovascular Goals 1.8 CEs
3. February 14, 2023 – Class 3 – Meds for Type 2 – What you need to know 1.5
4. February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
5. February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
6. February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
7. February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
8. March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
9. March 9, 2023 – Class 9 – Test-Taking Coach Session (48 Questions) No CE

All hours earned count toward your CDCES Accreditation Information

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The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.