Management of Diabetes Undergoing Elective Surgery

Patient Information Leaflet

These instructions are for patients with diabetes, treated with both:

·       Bolus insulin for mealtimes (eg Novorapid, Humalog, Apidra)

And

·      Background insulin (eg Lantus, Levemir, Insulatard, Humulin I, Degludec, Toujeo).

On the day before surgery

If you are on dapaglifozin, empagliflozin or canagliflozin, stop taking these drugs until after your operation and normal diet resumes.

Continue your usual diabetic medications and follow any bowel preparations as advised by your surgeon / staff at the pre-assessment clinic.

On the day of surgery

When your background insulin is due, you should take these as normal.

You should not take your mealtime bolus insulin from the time you are asked to fast.

If you are on dapagliflozin, canagliflozin and empagliflozin, you would have stopped taking these the day before.

Under special circumstances, your metformin may need to be withheld for 48 hours. Staff from the pre-assessment team will inform you of this.

You can continue taking other diabetic medication as usual.

Remember to bring to hospital all of your diabetes medications, dextrose tablets and blood testing equipment.

Your blood glucose will be tested by finger prick when you arrive to hospital and then monitored.

You can ask for extra blood testing if you feel symptoms of a ‘hypo’ (low blood glucose).

The target for safe surgery is 6 – 10 mmol. You may need insulin treatment to bring down high glucose, or dextrose infusion for treatment of low blood glucose.

After surgery

You will be discharged when you are eating and drinking normally and your blood glucose is at a safe level.

However, if you are unwell with:

• Continuous vomiting / diarrhoea, or high fever
• Unable to keep food down for four hours or more
• High blood glucose (>15.0 mmol by finger prick testing)
• High ketones (>0.6 mmol)

You should seek medical help. During office hours, contact your usual diabetes specialist nurse or doctor.

At other times, contact your local out-of-hours GP service.

If you have any questions, or if there is anything you do not understand about this leaflet, please contact:

The Diabetes and Endocrine Centre on 01384 244399

Russells Hall Hospital switchboard number: 01384 456111

If you have any feedback on this patient information leaflet, please email dgft.patient.information@nhs.net

Originator: Terence Pang, Chris Homer. Date originated: October 2013 Date reviewed: October 2025 Next review date: October 2028 Version: 3 DGH ref: DGH/PIL/00897