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Discussion

Insulin for type 2?

Hi all, I am having trouble grasping something. I work on a med/surg floor where many of our surgical patients are type 2 diabetics. During and after surgery, they are taken off of their oral antidiabetic meds, and put on AC and HS accuchecks and Humalog, sliding scale coverage. If these folks are insulin resistant, how is the insulin going to work for them? They already make insulin, just don't use it properly right? I know that at some point, the pancreas poops out and stops making insulin, even in type 2's, but how do you have any idea how much endogenous insulin they do have? The things that keep me awake at night...

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    Metformin is held around the time of surgery because of risk of lactic acidosis. Other diabetic meds, the kind that stimulate insulin production are held because their duration can be prolonged and po intake unpredictable.

    How much insulin is needed is sort of an educated guess. It is usually started at a low dose and titrated up according to glucose levels. Again, a lot depends on intake. Glucose levels may be high immediately after surgery due to stress (increasing cortisol and adrenaline levels), and limited activity. They will come back down gradually, and even ambulating 3-4 times a day will help to bring blood glucose down.

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    You are asking all of the right questions... you have a bright future... good on ya...exogenous intraoperative insulin works fine on these patients. Anesthetists give what works, whether that is 5 or 15 units of regular insulin ( its really all that we give perioperatively). Surgical stress is a game changer and conventional sugar control gets thrown out the door when trauma or surgery becomes involved.

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    Look up The Ominous Octet

    Every diabetic is a wee different. Hence all the different meds and insulins.

    Slide25.png

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