Insulin and Anesthetic Considerations

Question 1

T/F to produce its cellular effects, insulin diffuses through the cell membrane to bind to its target receptors?

Answer 1

False, insulin binds to a cell membrane receptor and does not diffuse into the cell

Question 2

T/F Regular insulin has the fastest onset and duration of action among the available formulations of insulin?

Answer 2

False, rapid acting insulin has the shortest onset and duration.

Question 3

List the following insulins from shortest to longest duration
Glarigine
Regular
Lispro
NPH

Answer 3

Lispro
Regular
NPH
Glarigine

Question 4

What triggers insulin release?

Answer 4

Elevated plasma glucose levels

Question 5

What is the difference between type I and type II diabetes?

Answer 5

Type I is insulin deficient and Type II is insulin resistent

Question 6

In the pre-operative setting , what must the anesthesia provider be aware of in a diabetic patient?

Answer 6

Cardiovascular function/Volume status
Renal Function/Electrolyte status
Patient’s Glycemic control
Aspiration prophylaxis

Question 7

T/F A significant risk of surgery is hypoglycemia due to the release of neuroendocrine hormones?

Answer 7

False, hyperglycemia is usually the concern

Question 8

T/F Intraoperative hyperglycemia serves as a protective mechanism for post-op infections and promotes wound healing?

Answer 8

False, impairs wound healing and increases infection.

Question 9

Where are the primary targets of insulin receptors?

Answer 9

The liver, muscle and adipose tissue (can be found on most cells of the body)

Question 10

What are the effects of the neuroendocrine stress response?

Answer 10

Increased glucose production and decreased insulin secretion leaders to hyperglycemia and ketosis

Question 11

What are goals in maintaining intraoperative glycemic management?

Answer 11

Maintain blood glucose in therapeutic range
Prevent metabolic disturbances related to hyper/hypoglycemia
Maintain fluid/electrolyte balance

Question 12

How often should you measure blood glucose if the patient is on an insulin gtt?

Answer 12

Q1H

Question 13

How should an elevated BG be treated while on an insulin gtt?

Answer 13

Sliding scale

Question 14

On average how much does 1 unit of insulin decrease the BG?

Answer 14

Decreases BG by 40-50mg/dL

Question 15

What is the half life and duration of Regular insulin and why is this important to know?

Answer 15

Regular insulin is used when the pt is on an insulin gtt,
1/2 Life: 7 min
duration:1 hr
Need to know if you are going to transition your patient from gtt to SQ injection in PACU

Question 16

How do you adjust your insulin gtt rate?

Answer 16

Rate = last BG/150