Medications and Surgery

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Medications and Surgery: Oral Hypoglycaemics, SGLT2 Inhibitors, Insulin, DOACs

Pre- and Post-Operative Advice

1. Oral Hypoglycaemics

• Pre-Op: Stop on the morning of surgery
• Post-Op: Restart once eating meals regularly

2. SGLT2 Inhibitors

• Pre-Op: Stop 3 days prior to reduce euglycaemic ketoacidosis risk
• Post-Op: Restart once eating and drinking normally

3. Insulin

• Long-Acting: Continue usual dose
• Short-Acting: Morning Surgery: Withhold morning dose Afternoon Surgery: Take half of the morning dose if a small breakfast is eaten

4. DOACs

• Pre-Op: Stop 48 hours prior for most procedures Low bleeding risk + normal eGFR: Stop 24 hours prior
• Post-Op: Resume 48 hours after surgery Low bleeding risk: Resume 24 hours post-op, regardless of eGFR

Monitoring

• Oral Hypoglycaemics: Monitor blood glucose post-op to prevent hyperglycaemia
• SGLT2 Inhibitors: Watch for euglycaemic DKA (abdominal pain, nausea)
• Insulin: Monitor intra- and post-op glucose levels to avoid hypo-/hyperglycaemia
• DOACs: Monitor for bleeding, especially in high-risk surgeries

Complications

• Hypoglycaemia with prolonged fasting
• Prolonged hyperglycaemia if not resumed promptly

• Euglycaemic ketoacidosis with fasting or illness
• Post-op dehydration ↑ ketoacidosis risk

• Hypoglycaemia from prolonged fasting or incorrect dosing
• Hyperglycaemia from missed doses

• Excessive bleeding if not stopped pre-op for high-risk surgeries
• Thromboembolism if not resumed promptly post-op

Additional Considerations

• Renal Function: Check pre-op to guide DOAC timing
• Bleeding Risk: Liaise with the surgical team to adjust medication timing based on the procedure