Surgery
Simplified JBDS guidelines - please see the link for more details:
| Day prior to admission | Day of surgery(morning operation) | Day of surgery (afternoon operation) | |
|---|---|---|---|
| Metformin* | Take as normal | If taken once or twice a day - takeas normalIf taken three times per day, omit lunchtime dose | If taken once ortwice a day - take as normalIf taken three times per day, omit lunchtime dose |
| Sulfonylureas | Take as normal | If taken once daily in the morning - omit the dose thatdayIf taken twice daily - omit the morning dose that day | If taken once daily in the morning -omit the dose that dayIf taken twice daily - omit both doses that day |
| DPP IV inhibitors (-gliptins) | Take as normal | Take as normal | Take as normal |
| GLP-1 analogues (-tides) | Take as normal | Take as normal | Take as normal |
| SGLT-2 inhibitors (-flozins) | Take as normal | Omit on the day of surgery | Omit on the day of surgery |
| Once daily insulins (e.g. Lantus, Levemir) | Reduce doseby 20% | Reduce dose by 20% | Reduce dose by 20% |
| Twice daily Biphasic or ultra-long acting insulins (e.g. Novomix 30, Humulin M3) | No dosechange | Halve the usual morning dose. Leave evening dose unchanged | Halve the usual morning dose. Leave evening dose unchanged |
assumes only one meal will be missed during surgery, eGFR is greater than 60 ml/min/1.73m and procedure not requiring the use of contrast media
2
Some procedures require special preparation:
Ramadan