This page explains pre-surgery instructions if you take a SGLT‑2 medication.
Following these instructions helps reduce anesthesia risks and keeps your care team informed about how your medication may affect your safety when having surgery at UVM Health.
Step 1: Identify Your Medication
Understanding which medication you take will determine which pre-surgery guidance you should follow.
Common SGLT-2 Medications
| Medication | Instructions |
|---|---|
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Step 2
If you take a SGLT-2 medication, review this guidance:
If you have diabetes, stop taking your SGLT-2 medication for the 3 days before your surgery.
- Diabetes has many names: Type 1, Type 2, insulin dependent, non-insulin dependent, pre-diabetes.
- It does not matter what kind of diabetes you have for this medication; this guidance is for any type of diabetes.
- If you have diabetes, it does not matter if you take insulin or pills to manage your blood sugar, the important thing is to know if you work with your doctor to manage diabetes.
- You might ALSO take a SGLT-2 for your heart. It is ok to stop taking the medication for a few days. Keep reading for more information.
- If you take Ertugliflozin (Steglatro), you should stop taking this the 4 days before your surgery.
Why Is This Important?
SGLT-2 medications affect how your body processes sugar (glucose) in the blood and urine. When you have surgery, we ask you to avoid eating before surgery, and this can cause a problem if you are taking a SGLT-2 medication.
If yes, you can stop taking your SGLT-2 medication on the same day as your surgery. You do not need to stop taking your SGLT-2 medication days before surgery.
- If you have diabetes, follow the diabetes 3-day rule above.
- These medications are commonly prescribed for “heart failure” or “chronic kidney disease.”
- These medications can help people, even if they do not have diabetes.
- It is safe to stop taking this medication for a short time, even if it is for your heart or kidneys.
When to Stop Taking SGLT-2 Medication Before Surgery
The goal is to skip your doses for 72 hours before surgery (96 hours for Steglatro). This table tells you when to take your last dose of SGLT-2 medication before surgery according to the day of the week. You will stop taking Steglatro (Ertugliflozin) longer than the other SGLT-2 medications.
| Your Surgery Day | Mon | Tues | Wed | Thurs | Fri | Sat | Sun |
|---|---|---|---|---|---|---|---|
| Take your last dose of SGLT-2 on this day | Thursday | Friday | Saturday | Sunday | Monday | Tuesday | Wednesday |
Step 3: Day of Your Surgery
- You will meet a nurse in Pre-op who will ask you questions about your medication.
- Tell them the day you took your last dose of SGLT-2 medication.
- Tell them about the other medications you take. You might have a last dose for those medications too. You might have been instructed to take them the day of surgery.
- You may have a long list of medications. We recommend you write a list of your medications or ask for a family member to help.
Frequently Asked Questions
These medications affect how your body process sugar. Your body receives sugar, protein, carbohydrates and fats from the food you eat, and most people eat something every day. Before surgery, we ask that you avoid eating anything for at least 8 hours (sometimes longer), and you might not start eating again for a few hours or days depending on the type of surgery you are having. Do not worry, most patients start eating after surgery as soon as they are hungry.
If you still have the medication in your body when you are not eating, you can have a rare but life-threatening condition called euglycemic diabetic ketoacidosis (euDKA). This is hard to diagnose and requires specialist doctors to help treat it. This is especially important for people who have diabetes. If you have stopped the medication before surgery, the risk of this condition is much lower and it is safe to go forward with surgery.
If you do not follow these instructions, anesthesia and surgery may be less safe for you, and your surgery may be cancelled. You would then need to reschedule your surgery for another day.
You will get instructions before you leave the hospital for what to do with your medications. You can always call your doctor to ask about when to start taking them. For SGLT-2 medications, you can start taking them again once you feel like you are able to eat again. In general, the day after surgery is ok to start taking your SGLT-2 medication again if you are eating normally. If you have special eating instructions after surgery, it is best to ask your doctor about what to do with your SGLT-2 medication.