On the morning of surgery, which adjustment should be made to basal insulin?

• A. Continue full dose of basal insulin
• B. 1/2 dose of basal (slow acting)
• C. Stop basal insulin completely
• D. Increase basal insulin by 50%

Answer: (B)

Managing basal insulin around surgery centers on balancing the fasting state with the body’s stress response to surgery. In the morning of surgery, patients are usually fasting, so the need for background insulin drops. Giving a full usual basal dose during this time can drive glucose too low under anesthesia, so the safest and most effective approach is to reduce the basal to about half the usual amount. This half-dose provides enough background insulin to cover hepatic glucose production and the stress of surgery while minimizing the risk of hypoglycemia. Keep in mind that rapid-acting insulin is typically held when there is no oral intake, but the basal dose is scaled back rather than stopped.