A 55-year-old diabetic woman on long-term insulin therapy is brought for elective cholecystectomy. Her morning blood glucose is 210 mg/dL. Which is the MOST appropriate perioperative glucose management target during major abdominal surgery?

• A Maintain blood glucose 80–110 mg/dL with intensive insulin infusion
• B Withhold all insulin to prevent intraoperative hypoglycaemia
• C Target blood glucose < 140 mg/dL with tight control
• D Maintain blood glucose 140–180 mg/dL; avoid hypoglycaemia ✓

Explanation

Current guidelines (AACE/ADA and anaesthesia society protocols) recommend a target range of 140–180 mg/dL for most hospitalised surgical patients. Intensive control targeting 80–110 mg/dL (NICE-SUGAR approach) increased mortality due to hypoglycaemic episodes, which are more dangerous and less detectable under general anaesthesia. Withholding all insulin is inappropriate as hyperglycaemia impairs wound healing and increases infection risk.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.