A 58-year-old man with type 2 diabetes takes empagliflozin, metformin, and glimepiride. He is posted for elective hernia repair next week. Which drug modification is most important before surgery?

• A Stop metformin one week before surgery
• B Continue all medications unchanged through the morning of surgery
• C Stop empagliflozin three days before surgery ✓
• D Substitute insulin for glimepiride one week before surgery

Explanation

SGLT2 inhibitors impair renal glucose excretion handling during surgical stress and fasting, predisposing to euglycaemic diabetic ketoacidosis, where blood glucose may be near normal while pH falls dangerously. Current practice is to withhold them about three days preoperatively. Metformin is stopped only on the day of surgery (or 24 to 48 hours if renal risk factors exist), not a week before. Routine conversion to insulin is unnecessary for diet-friendly minor surgery with good control.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.