A 60-year-old man with type 2 diabetes mellitus attended for an elective laparoscopic cholecystectomy. His oral hypoglycaemic medication regimen was metformin 1 g twice daily and gliclazide 160 mg twice daily. His haemoglobin A1c concentration had been 69 mmol/mol (20C42) when checked 2 months previously.
He was admitted on the morning of surgery and was on the morning list. He had fasted from midnight and taken metformin 1 g at 05.00 h.
On examination, he weighed 82 kg.
Investigations (on admission):
serum creatinine64 µmol/L (60C110)
fasting plasma glucose18.1 mmol/L (3.0C6.0)
capillary blood ketones0.2 mmol/L (<1)
According to the Joint British Diabetes Societies guideline ‘Management of adults with diabetes undergoing surgery and elective procedures’, what is the most appropriate next step in management to bring his preoperative glucose into the acceptable range (4.0C12.0 mmol/L)?
A . cancel surgery and refer to local diabetes team
B . gliclazide 160 mg orally
C . rapid-acting analogue insulin 8 units subcutaneously
D . rapid-acting analogue insulin 16 units subcutaneously
E . variable-rate insulin infusion
Answer: C