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Perioperative diabetes medication safety 💊
For education and revision only. Check current NICE/BNF, specialist guidance and local NHS policy before clinical use. Newly added V19 material has not received independent clinical sign-off.
Operations and fasting alter insulin requirements, glucose physiology and the risks of hypoglycaemia or ketoacidosis. A written perioperative diabetes plan is essential.
Before procedure
- Identify diabetes type, usual insulin, oral agents, SGLT2 inhibitors, last dose, fasting status, glucose/ketones and recent acute illness.
- Do not omit basal insulin in type 1 diabetes; avoid an unsupervised variable-rate insulin infusion or duplicate insulin prescriptions.
Around surgery
- Use the local perioperative diabetes protocol for drug holds/restarts, IV fluids and frequent glucose/ketone monitoring.
- SGLT2 inhibitors can be associated with euglycaemic ketoacidosis around fasting or acute illness; check ketones if unwell despite a modest glucose result.
- Document postoperative food intake, insulin plan, escalation and handover to ward/diabetes team.
Clinical reasoning: An apparently normal glucose reading does not rule out significant ketosis with SGLT2 inhibitor exposure.
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