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Perioperative diabetes management — SCE Endocrinology MCQ

Instant feedback + full explanation. One question, done properly.

HardDiabetesPerioperative diabetes managementSCE Endocrinology

A 66-year-old woman with type 2 diabetes is admitted with fractured neck of femur and is nil by mouth. She usually takes basal insulin, metformin and dapagliflozin. Glucose is 15 mmol/L, ketones 0.4 mmol/L, eGFR 41 ml/min/1.73 m² and surgery is planned tomorrow morning. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Withhold oral agents and use a variable-rate insulin infusion with basal insulin review

Major surgery with fasting and acute illness usually requires withholding oral agents, avoiding SGLT2 inhibitors and maintaining safe insulin coverage. Stopping all insulin risks ketosis, especially under stress. The pearl is that perioperative diabetes care is about metabolic stability, not merely a normal glucose reading.

Reference: Centre for Perioperative Care diabetes guideline, JBDS inpatient diabetes guidance