E. Omit sitagliptin on the day of the procedure – Explanation
Perioperative management of diabetes is often quite confusing. Below are guIdelines
that give you an idea of which medications need to be stopped and when they can be
restarted. It is not an exhaustive list and different hospitals have different protocols for
diabetic medications but the general concept is still there.
The highlighted boxes represent frequently asked topics which you should memorize
| Insulin type and frequency |
Day prior to admission | Day of surgery | After surgery |
| Long-acting insulin, taken once a day in the evening |
Take as usual | See ‘after surgery’ box | Restart once eating and
drinking |
| Long-acting insulin, taken once a day in the morning |
Take as usual | Reduce usual dose by approximately 1/3 for each expected omitted meal |
Restart once eating and drinking |
| Twice daily insulins eg mixed or intermediate acting |
Take as usual | Half usual morning dose | Restart once eating and
drinking |
| Three times a day (mealtime) insulin |
Take as usual | Omit doses on meals that are to be missed |
Restart once eating and drinking |
| Types of non-insulin anti-diabetic medicines |
Day before surgery | Day of surgery | After surgery |
| Acarbose | Take as normal | Omit dose if missing
meal |
Row 2, Restart once eating and drinking4 |
| Meglitinide (e.g. gliclazide, glipizide) |
Take as normal | Omit dose if missing
meal |
Restart once eating and drinking |
| Short acting sulphonyl ureas (e.g. glibenclamide) |
Take as normal | Omit dose if missing
meal |
Restart once eating and drinking |
| Long acting sulphonylureas (e.g. glibenclamide) |
Take as normal | Omit dose if missing
meal |
Restart once eating and drinking |
| Metformin (including Glucophage SR) |
Take as normal (unless surgery with contrast dye – needs to be stopped two days before surgery) |
Take as normal (unless surgery with contrast dye – needs to be stopped two dayslumn 3 before surgery))_ |
Take as normal (unless surgery with contrast dye – needs to be stopped two days before surgery) |
| Take as normal | Take as normal | Restart once eating and
drinking |
|
| Pioglitazone | Take as normal | Omit dose if missing
meal |
Restart once eating and
drinking |
| DPP IV inhibitor (e.g. sitagliptin, vildagliptin, saxagliptin) |
Take as normal | Omit dose if missing
meal |
Restart once eating and
drinking |
| Long-actingGLP-1 analogue (e.g. exenatide) |
Take as normal | Omit dose if missing
meal |
Restart once eating and
drinking |
Blood glucose should be checked regularly before, during and after the operation. If at
any point the blood glucose level is higher than 11 mmol/L, consider starting an insulin
infusion intravenously.
