Please follow the instructions in the ‘What to do with your medication before surgery‘ section further down this page regarding your particular medication.
If your operation is in the morning:
Do not
- Eat any food after midnight
Do
- Drink water only up to 6am
If your operation is in the afternoon:
Do
- Eat breakfast before 7am and take no food after this time.
- Drink water only up to 10am.
- When you travel to and from the hospital for your operation carry some glucose tablets or a sugary drink.
Before your admission to hospital
If you have any symptoms of a low blood sugar such as sweating, dizziness, blurred vision or shaking please test your blood sugar if you are able to do so. If it is less than 4 mmol/L take four glucose tablets or 150 mls of a sugary drink (this is the same as half a standard sized can of non-diet cola). Please tell staff at the hospital that you have done this.
During your stay on the admissions lounge
If you have any symptoms of a low blood sugar such as sweating, dizziness, blurred vision or shaking please test your blood sugar if you are able to do so. If your blood sugar is less than 4 mmol/L please tell a member of staff.
After your operation
After your operation you will be offered food and drink when you feel able to eat. Once you are eating and drinking normally you should resume taking your normal tablets. However, your blood glucose levels may be higher than usual for a day or so.
If you have any concerns about your diabetes care/control of your blood sugars, either before or after your operation please contact your usual diabetes team
If you are in the Leeds area, or are unable to contact your usual team please contact:
The Leeds Teaching Hospitals Diabetes Helpline
09:00-17:00, Mon-Fri
Outside these hours please contact your GP practice or out of hours service.
Remember to bring the following with you to hospital:
- Blood glucose testing equipment (if you usually monitor your blood glucose).
- The tablets/injections you usually take for your diabetes.
- Instructions for taking your diabetes medication before your operation.
What to do with your medication before surgery
| Tablets | |||
|---|---|---|---|
| Day before your surgery | Day of surgery | ||
| Morning surgery | Afternoon surgery | ||
| Acarbose | Take as normal | Do not take your morning dose | If eating breakfast – take your morning dose. Do not take your lunchtime dose |
| DPP-IV inhibitors These include; Sitagliptin, Saxagliptin, Vildagliptin, Linaglitpin Alogliptin | Take as normal | Take as normal | Take as normal |
| Meglitinide Repaglinide | Take as normal | If you have been told to fast from midnight – do not take your morning dose | Only take your morning dose if eating breakfast. Do not take your lunchtime dose. |
| Tablets, continued | |||
|---|---|---|---|
| Day before your surgery | Day of surgery | ||
| Morning surgery | Afternoon surgery | ||
| Metformin* | Take as normal | Take as normal | Take as usual in the morning but do not take your lunchtime dose |
| Pioglitazone | Take as normal | Take as normal | Take as normal |
| SGLT2 inhibitors These include; Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin, Vokanamet®, Xigduo® | Do not take your tablets | Do not take your tablets | Do not take your tablets |
| Sulphonylureas These include; Glibenclamide, Glipizide, Gliclazide, Glimepiride | Take as normal | If you have been told to fast from midnight do not take your morning dose | Do not take your tablets |
*If contrast medium is to be used and eGFR less than 60ml/min/1.73m2, metformin should be omitted on the day of the procedure and for the following 48 hours.
| Combination products | ||
|---|---|---|
| Day before surgery | Day of surgery | |
| Metformin+ pioglitazone Competact® | Continue | Continue |
| Metformin+ DPP-IV Inhibitors These include: Eucreas® Janumet® Jentadueto® Komboglyze® Vipdomet® | Continue | Continue |
| Metformin+ SGLT-2 Inhibitors These include: Synjardy® Vokanamet® Xigduo® | Do not take your tablets | Do not take your tablets |
| SGLT-2 Inhibitors + DPP-IV Inhibitors These include: Glyxambi® Qtern® | Do not take your tablets | Do not take your tablets |
| Injections | |||
|---|---|---|---|
| Day before your surgery | Day of surgery | ||
| Morning surgery | Afternoon surgery | ||
| GLP-1 analogues These include; Exenatide, Liraglutide, Victoza®, Semaglutide, Tirzepatide, and Bydureon® | Take as normal | Take as normal | Take as normal |
| Intermediate and long acting Insulin These include; Abasaglar, Humulin I, Insuman Basal, Lantus, Levemir, Semglee, Toujeo, Tresiba, Suliqua, Xultophy | |||
| If you inject once a day on a MORNING | Inject as normal | Give 80% of your usual dose in the morning before surgery……..units | |
| If you inject once a day at LUNCHTIME | Give 80% of your usual dose at the usual time you inject…………..units | Give full dose (usual dose) of insulin after your surgery once eating and drinking | |
| If you inject once a day in an EVENING | Give full dose (usual dose) of insulin after your surgery once eating and drinking | ||
| Injections, continued | ||
|---|---|---|
| Day before surgery | Day of surgery | |
| If you inject twice a day | Inject your morning dose as usual but only inject 80% of usual evening dose…………..units | Give 80% of your usual dose in the morning before surgery……..units Take your full (usual) dose after your surgery once eating and drinking |
| Twice daily injections of pre-mixed insulin | ||
|---|---|---|
| Day before surgery | Day of surgery | |
| These include: Humalog Mix 25, Humalog Mix 50, Humulin M3, Hypurin porcine (30/70mix), Insuman Comb 25, Insuman Comb 50, Novomix 30 | Inject as normal | Give 50% of your usual dose in the morning before surgery……..units Take your full (usual) dose after your surgery once eating and drinking |
| Three times a day injections of pre-mixed insulin | |||
|---|---|---|---|
| Day before your surgery | Day of surgery | ||
| Morning surgery | Afternoon surgery | ||
| These include: Humalog Mix 25, Humalog Mix 50, Humulin M3, Hypurin porcine (30/70mix), Insuman Comb 25, Insuman Comb 50, Novomix 30 | Take as normal | Give 50% of your usual dose in the morning before surgery……..units DO NOT TAKE A LUNCHTIME DOSE Take your full (usual) dose after your surgery once eating and drinking | Take your usual morning dose. DO NOT TAKE A LUNCHTME DOSE Take your full (usual) dose after your surgery once eating and drinking. |
| Twice daily (separate) injections of a short acting insulin AND an intermediate acting insulin | ||
|---|---|---|
| Day before your surgery | Day of surgery | |
| These include: Short acting insulin: Actrapid, Apidra, Humalog, Humulin S, Insuman rapid, Novorapid Intermediate acting insulin: Humulin I, Insulatard, Insuman basal, Isophane insulin | Take as normal | Give 80% of your morning intermediate acting insulin only…….…units Take your full (usual) dose after your surgery once eating and drinking. |
| Basal bolus regimen | |||
|---|---|---|---|
| Day before your surgery | Day of surgery | ||
| Morning surgery | Afternoon surgery | ||
| This includes: three or more injections of short acting insulin with one or two injections of intermediate/long acting insulin as part of a basal bolus regimen | Take as normal | DO NOT TAKE your morning or lunchtime dose of short acting insulin. If intermediate/long acting insulin taken on a morning give 80% of your usual dose…….…units | Take your usual dose of short acting insulin in the morning. DO NOT TAKE YOUR LUNCHTIME DOSE. If intermediate/long acting insulin taken on a morning give 80% of your usual dose …….…units |
| Humulin R U500 insulin |
|---|
| Patients using Humulin R U500 will be given personalised advice from the diabetes team. If you have not heard from the diabetes team before your operation date, please contact the Leeds Teaching Hospitals Diabetes Helpline on 0113 206 5068. |
| Continuous subcutaneous insulin infusion pumps | ||
|---|---|---|
| Insulins | Day before admission | Day of surgery |
| Continuous subcutaneous insulin infusion pump (CSII) / Hybrid Closed Loop (HCL) These include: Medtronic, Roche, Omnipod | No dose change | No change in basal rate. In certain circumstances, you may be asked to reduce your basal rate by 80% Please know this is temporary. If you are to reduce your rate, your new rate is…….…units Only change your rate if advised to do so by a member of our diabetes team |