📌 Quick-Tip: Can You Recall When to Stop Diabetes Meds Before Surgery?🤔

⚠️ SGLT2 Inhibitors: Need the Longest Hold

• Stop 3 days before surgery (e.g., canagliflozin, empagliflozin, dapagliflozin).
• Prevents euglycemic diabetic ketoacidosis (euDKA), which can occur even with near-normal glucose.
• 💡 This is the most critical timing to remember.

💊 Metformin (a Biguanide): Hold 1–2 Days Before

• Metformin is a biguanide agent that suppresses hepatic gluconeogenesis and improves insulin sensitivity.
• Stop the day before or morning of surgery to avoid lactic acidosis, especially when renal function may decline due to dehydration, hypotension, or contrast exposure.
• ✅ Resume only after confirming stable postoperative renal function.

🍽️ Sulfonylureas and Glinides: Hold the Day Before

• These insulin secretagogues increase hypoglycemia risk during fasting.
• Stop glimepiride, glyburide, and repaglinide the day before or morning of surgery.
• Safe to restart once the patient resumes oral intake.

💊 DPP-4 Inhibitors: Usually Safe to Continue

• Low hypoglycemia risk (sitagliptin, linagliptin).
• For major surgery or prolonged fasting, consider holding the morning dose.
• Restart with the first postoperative meal.

🧬 GLP-1 Receptor Agonists: Depends on Formulation

• Weekly injections: stop 1 week before surgery (they delay gastric emptying and increase aspiration risk).
• Daily formulations: stop on the morning of surgery.
• Resume once oral intake is tolerated.