Medication instructions

Specific medications

SGLT-2 Inhibitors

SGLT2 inhibitors (like empagliflozin, dapagliflozin, canagliflozin, ertugliflozin) can cause euglycemic diabetic ketoacidosis (euDKA) during periods of fasting, surgical stress, or reduced oral intake. Recommendation is stop SGLT2 inhibitors before surgery to reduce the risk.

Elective surgery (general anesthesia): stop 3 days before surgery (unless otherwise specified)

Other diabetes medications

1. Metformin

  • Stop: On the day of surgery (stop 2 days before if procedure uses contrast)

  • Restart: once eating and renal function is normal

2. Sulfonylureas (e.g., gliclazide, glibenclamide)

  • Stop: Morning of surgery

  • Restart: Postoperative once patient is eating

3. DPP-4 inhibitors (gliptins, e.g., sitagliptin, linagliptin)

  • Stop: Morning of surgery

  • Restart: Post-op when patient is eating

4. GLP-1 receptor agonists (e.g., semaglutide, liraglutide)

  • Stop: Optional, but often continue; may hold day of surgery if nausea expected

5. Insulin

  • Long-acting (basal) insulin: Reduce dose by 20–50% the night before or morning of surgery

  • Short-acting / mealtime insulin: Usually hold if fasting

  • Restart: Post-op when eating

Aspirin, clopidogrel, warfarin, NOAC and other anticoagulants

Procedure and patient specific