1.  A type II
diabetic is going for a surgery.  What
information do you need to recommend proper diabetes
management?

2.  You are
asked at 6 p.m. by the orthopedics service to “clear” an 80 year-old woman with
type II diabetes for an ORIF of her hip sometime tomorrow.  The patient normally takes glyburide 10 mg bid, metformin
1000 bid, actos 45 mg qd,
and Lantus 30 U qhs.  Her last HbA1c was 7.3%.  She has had a few episodes of hypoglycemia
with sugars in the 50’s at home, which she self-treated with orange juice.  Currently fingerstick glucose is 250.
She will be overnighted in the surgical
step-down unit and kept NPO.

3. Urology refers an 65
year-old man to you for preoperative consultation.  He will be going for TURP in three
weeks.  The patient takes metformin and glyburide and has
HBA1c of 8.8%. 

4. Vascular Surgery pages you to recommend diabetes
managment for a 70 year-old woman going for a transmetatarsal amputation for gangrenous toes in the
morning.  The patient is a brittle type
II diabetic who’s current home regimen is 50 U NPH with 15 R in the am and 40 U
NPH with 15R before dinner.  She tells
you her sugar is “up and down.”  Her
husband provides fingerstick log.  The patient varies from fingersticks in the 50’s to fingersticks in the 300’s without apparent pattern.  Current fingerstick
is 80.