title: Preoperative hypoglycemia in a patient receiving insulin detemir.
abstract: The insulin regimen of a Type 2 diabetic presenting for surgery had been changed recently from a 70/30 mixture of insulin aspart protamine and aspart to insulin detemir and insulin glulisine. Preoperative instructions were to take the usual dose of basal, but none of the short-acting insulin. On the morning of surgery, the patient's blood glucose was low and remained so despite i.v. dextrose administration. A review of the basal insulin dose revealed that it had been inappropriately increased to control elevated postprandial glucose. Doses of basal insulin in excess of basal requirements will cause hypoglycemia in the fasting state.
authors.affiliation: Preoperative Screening Unit, Department of Anesthesiology, PO Box 3094 DUMC, Durham, NC 27710, USA. ron.olson@duke.edu
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Olson
authors.forename: M Angelyn
authors.initials: MA
authors.lastname: Bethel
authors.forename: Lillian
authors.initials: L
authors.lastname: Lien
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005215:Fasting / Q000502:physiology; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069057:Insulin Detemir; D049528:Insulin, Long-Acting; D011300:Preoperative Care
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069057:Insulin Detemir