A 60-year-old diabetic patient undergoing major abdominal surgery has an intraoperative blood glucose of 280 mg/dL. According to current perioperative guidelines, at what threshold should an insulin infusion be initiated in a critically ill surgical patient?

• A Blood glucose above 140 mg/dL
• B Blood glucose above 250 mg/dL
• C Blood glucose above 180 mg/dL ✓
• D Blood glucose above 300 mg/dL

Explanation

Current guidelines (ADA and critical care consensus) recommend initiating insulin therapy when blood glucose exceeds 180 mg/dL in critically ill patients, targeting a range of 140 to 180 mg/dL. A threshold of 140 mg/dL is too tight and risks hypoglycaemia. Waiting until 250 or 300 mg/dL exposes the patient to the risks of hyperglycaemia, including impaired wound healing, infection and osmotic diuresis.

Reference: Miller's Anaesthesia, 9th ed.

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