A 66-year-old man with type 2 diabetes takes metformin and an SGLT2 inhibitor and is listed for elective surgery. What is the key consideration for the SGLT2 inhibitor?
Answer and explanation
Correct answer: A. Stop it before surgery because of the risk of euglycaemic ketoacidosis
- Step 1: SGLT2 inhibitors cause ketosis even when glucose is near normal.
- Step 2: Guidance advises omitting them for at least a day before and until eating normally afterwards.
Answer
Stop it before surgery because of the risk of euglycaemic ketoacidosis.
Why not the others: Continue it unchanged throughout the fasting period, as the dose does not matter: Continuing increases ketoacidosis risk. Replace it with a morning sulfonylurea taken just before he is fasted: A sulfonylurea during fasting risks hypoglycaemia. Double the dose to prevent hyperglycaemia on the day of surgery: Doubling makes ketosis more likely.
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