Management of Basaglar (Insulin Glargine) Before Breast Lumpectomy
Basaglar (insulin glargine) should be continued before breast lumpectomy, but the dose should be reduced to 75-80% of the usual dose on the day of surgery to maintain glycemic control while minimizing hypoglycemia risk.
Perioperative Insulin Management Guidelines
The American Diabetes Association provides clear guidance on insulin management during the perioperative period for surgical procedures like breast lumpectomy:
- For long-acting insulin analogs like Basaglar (insulin glargine), administer 75-80% of the usual dose on the day of surgery 1
- Reducing basal insulin by 25% the evening before surgery achieves better perioperative glucose control with lower hypoglycemia risk 2
- Blood glucose should be maintained between 100-180 mg/dL (5.6-10.0 mmol/L) during the perioperative period 2
Specific Considerations for Breast Lumpectomy
Breast lumpectomy is considered minor-to-moderately invasive surgery 2, and special attention should be paid to:
- Monitor blood glucose every 2-4 hours while the patient is fasting 2, 1
- Administer short-acting or rapid-acting insulin as needed to maintain target glucose levels 2
- Basal-bolus insulin regimens are associated with improved outcomes compared to correction-only insulin coverage 2
Safety Considerations
There are several important safety considerations when managing Basaglar before breast lumpectomy:
Hypoglycemia risk: Complete discontinuation of basal insulin like Basaglar could lead to hyperglycemia and metabolic decompensation, particularly in patients with type 1 diabetes who are at risk for diabetic ketoacidosis 2, 1
Hyperglycemia risk: Inadequate insulin dosing can lead to perioperative hyperglycemia, which increases the risk of surgical site infections and other complications 2
Aspiration risk: Unlike GLP-1 receptor agonists, which have been associated with increased risk of regurgitation and pulmonary aspiration during anesthesia 2, insulin glargine does not delay gastric emptying and does not pose this specific risk
Special Circumstances
- Type 1 diabetes: Patients with type 1 diabetes should never completely discontinue insulin due to risk of diabetic ketoacidosis 2, 1
- Insulin pump users: Adjust basal rates based on clinical judgment rather than stopping insulin 2, 1
- Patients on multiple diabetes medications: Hold oral antidiabetic medications on the day of surgery 2, 1
Resuming Normal Insulin Dosing
- Resume the usual Basaglar dose once the patient is eating normally after surgery
- Monitor blood glucose closely during the transition period
- Adjust insulin doses as needed based on nutritional intake and blood glucose levels
There is no evidence suggesting that insulin glargine (Basaglar) increases breast cancer risk or affects surgical outcomes in breast lumpectomy patients 3, 4. Earlier concerns about potential associations between insulin glargine and breast cancer 5, 6 have not been substantiated in more recent, larger studies 4.