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
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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
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Complications
1. Oral Hypoglycaemics
Hypoglycaemia with prolonged fasting
Prolonged hyperglycaemia if not resumed promptly
2. SGLT2 Inhibitors
Euglycaemic ketoacidosis with fasting or illness
Post-op dehydration ↑ ketoacidosis risk
3. Insulin
Hypoglycaemia from prolonged fasting or incorrect dosing
Hyperglycaemia from missed doses
4. DOACs
Excessive bleeding if not stopped pre-op for high-risk surgeries
Thromboembolism if not resumed promptly post-op
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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
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