Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases?

Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases?

• A. Renal disease
• B. Rheumatoid arthritis requiring high-dosage prednisone
• C. Chronic obstructive lung disease treated with a terbutaline inhaler and aminophylline
• D. Manic-depressive disorder treated with lithium

Answer: (A)

The key idea is that impaired kidney function makes hypoglycemia more likely in a diabetic patient going to surgery. The kidneys help clear insulin from the bloodstream, so when renal disease is present, insulin stays active longer. That means even standard insulin doses or secretagogues can push glucose down too far, especially during fasting in the perioperative period. In addition, the kidneys contribute to glucose production during fasting through gluconeogenesis; when kidney function is poor, this source of glucose is reduced, making drops in blood sugar more likely. The other conditions listed tend to affect glucose in different ways: steroids like prednisone raise blood sugar, beta-agonists and related drugs can also raise glucose, and lithium doesn’t directly cause hypoglycemia. So renal disease creates a unique, stronger risk for perioperative hypoglycemia in a diabetic patient. Clinically, this means closer glucose monitoring and possible adjustment of insulin or ongoing glucose support for patients with renal impairment.

The key idea is that impaired kidney function makes hypoglycemia more likely in a diabetic patient going to surgery. The kidneys help clear insulin from the bloodstream, so when renal disease is present, insulin stays active longer. That means even standard insulin doses or secretagogues can push glucose down too far, especially during fasting in the perioperative period. In addition, the kidneys contribute to glucose production during fasting through gluconeogenesis; when kidney function is poor, this source of glucose is reduced, making drops in blood sugar more likely.

The other conditions listed tend to affect glucose in different ways: steroids like prednisone raise blood sugar, beta-agonists and related drugs can also raise glucose, and lithium doesn’t directly cause hypoglycemia. So renal disease creates a unique, stronger risk for perioperative hypoglycemia in a diabetic patient. Clinically, this means closer glucose monitoring and possible adjustment of insulin or ongoing glucose support for patients with renal impairment.