American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended approach to manage diabetes mellitus medications in the preoperative setting?

1. Withhold all insulin

2. Continue long-acting insulin and withhold short-acting insulin

3. Administer only short-acting insulin

4. Continue all insulin at half doses

The correct answer is: Continue long-acting insulin and withhold short-acting insulin

The recommended approach to manage diabetes mellitus medications in the preoperative setting typically involves continuing long-acting insulin while withholding short-acting insulin. This strategy is particularly effective in mitigating the risk of significant hyperglycemia while also preventing hypoglycemia, which can occur due to fasting and altered intake during the perioperative period. Long-acting insulin helps to maintain baseline glycemic levels throughout the day and is less likely to cause rapid fluctuations in blood sugar, which is crucial given the stress and potential for changes in nutritional intake associated with surgery. On the other hand, withholding short-acting insulin is typically advisable because there may not be an adequate nutritional intake to match the rapid action of these insulin types. When patients fast, the risk for hypoglycemia increases if short-acting insulin is administered without food intake. In addition, by continuing long-acting insulin, the patient can maintain a more stable glucose level, which is essential for recovery and overall surgical outcomes. This management helps to optimize the patient’s metabolic state, decreasing the likelihood of complications related to diabetes during and after surgery. Other strategies, such as administering only short-acting insulin or continuing all insulin at half doses, do not align with the best practices for the preoperative management of diabetes, as