Introduction

Managing diabetes effectively before any surgery is essential to reduce complications and ensure better healing outcomes. Cataract surgery, though commonly performed, requires good glycemic and blood pressure control before the procedure. This case highlights the importance of timely intervention, medication optimization, insulin initiation, and close follow-up in achieving rapid diabetes control before surgery.

Patient Background

A female patient presented with a history of type 2 diabetes mellitus for the last 7–8 years and hypertension for 4–5 years. She visited the clinic with the intention of undergoing cataract surgery within the next one month.

At presentation:

  • Random blood sugar: 268 mg/dL
  • Fasting blood sugar: 240 mg/dL
  • HbA1c: 10.3%, indicating significantly uncontrolled diabetes

Other investigations including hemoglobin, cholesterol profile, and routine blood reports were within normal limits. Blood pressure was also monitored carefully during evaluation

Clinical Approach

Considering the uncontrolled diabetes and the urgency of planned cataract surgery, an intensive treatment strategy was initiated.

Medication Optimization

The dose of Glimepiride + Metformin was increased from 1 mg/500 mg to 2 mg/500 mg.

Sitagliptin 100 mg once daily was added to improve glycemic control.

However, due to:

  • Long-standing diabete
  • High HbA1c levels
  • Need for faster sugar control before surgery
  • The decision was made to initiate insulin therapy

The patient was started on:

  • Premixed insulin (Ryzodeg) , 10 units before breakfast , 8 units before dinner.
  • She was advised to administer insulin 5–10 minutes before meals.
  • Lifestyle & Monitoring
  • Continuous self-monitoring of blood glucose (SMBG) using a glucometer was advised.
  • A detailed diet consultation and dietary modifications were done.

The patient followed up regularly every week for dose adjustments and monitoring.

Outcome

Over the next 2–3 weeks, insulin doses were gradually titrated according to blood glucose readings.

Final insulin requirement:

  • 14 units before breakfast
  • 12 units before dinner

With close monitoring, dietary compliance, and insulin adjustments:

  • Blood sugar levels improved significantly
  • Blood pressure remained under control
  • The patient became medically fit to undergo cataract surgery successfully

Doctor’s Perspective

This case demonstrates the importance of individualized diabetes management, especially in patients requiring urgent surgical intervention. In long-standing diabetes with significantly elevated HbA1c levels, oral medications alone may not provide adequate control within a short time frame. Early initiation of insulin, combined with patient education and close follow-up, can rapidly optimize glycemic status and improve surgical readiness and outcomes.

Key Learning Points

  • Good glycemic control is essential before elective surgeries such as cataract surgery.
  • HbA1c helps assess long-term diabetes control and guides treatment intensity.
  • Patients with long-standing uncontrolled diabetes may require early insulin initiation.
  • Frequent follow-up and insulin dose titration are critical for achieving target sugars.
  • Diet modification and self-monitoring of blood glucose play a major role in diabetes management.
  • A multidisciplinary approach improves patient outcomes before surgery.

Conclusion

This case highlights how timely intervention, structured follow-up, insulin therapy, and lifestyle modifications helped achieve rapid diabetes control in a patient with long-standing uncontrolled diabetes preparing for cataract surgery. With comprehensive diabetes management, the patient became fit for surgery while maintaining stable blood pressure and improved glycemic status.