This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Olson, R. P. Articles by Lien, L. Search for Related Content PubMed PubMed Citation Articles by Olson, R. P. Articles by Lien, L. Related Collections Complications Patient Safety Pharmacology

---

PATIENT SAFETY

Preoperative Hypoglycemia in a Patient Receiving Insulin Detemir

Ronald P. Olson, MD^*, M. Angelyn Bethel, MD, and Lillian Lien, MD

From the *Department of Anesthesiology, Division of Endocrinology, Durham, NC; and Department of Medicine, Duke University.

Address correspondence to Ronald P. Olson, MD, Preoperative Screening Unit, Department of Anesthesiology, PO Box 3094 DUMC, Durham, NC 27710. Address e-mail to ron.olson{at}duke.edu.

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 IV 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.