(1)   The following statements about surgery in diabetics is true except

 (a)    Elective surgery should be postponed till good glycemic control is achieved

(b)   On the morning of surgery oral hypoglycaemic agents should be given

(c)    The patient who is under good control need to be switched over to insulin for intraoperative glycemic control in case of prolonged surgeries.

(d)   Surgery on diabetics needs to be scheduled early in the morning.

 Answer: The answer is (b). Major surgeries need a period of fasting starting the previous night of the surgery, therefore oral hypoglycemic agents cannot be given on the morning of surgery. It is advisable to postpone elective surgeries till a good control of the blood sugars is achieved. Insulin is the best agent for glycemic control perioperatively. This is especially true in case of long drawn surgeries where a few doses need to be given intraoperatively. Usually surgeries on diabetics need to be scheduled early in the morning because it will avoid a long period of fasting.

Metformin has a risk of lactic acidosis so should be discontinued at least 48 hours ahead of scheduled elective surgery.