Table 1 Oral and injectable antihyperglycemic agents—preoperative management
From: Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery
Class | Drug | Physiological effect | Risk of hypoglycemia | Day before surgery | Day of surgery |
|---|---|---|---|---|---|
Biguanides | Metformin | Decrease hepatic glucose production | Low | Continue regular use | Omit dose if eGFRÂ <Â 60Â ml/min/1.73Â m2 or if IV contrast anticipated. If not, take morning dose |
Sulfonylureas | Gliclazide, glipizide, glimepiride | Increase insulin secretion | Moderate to high | Continue regular use | Omit dose |
Thiazolidinediones | Rosiglitazone, pioglitazone | Increase insulin sensitivity | Low | Continue regular use | Omit dose |
Glinides | Nateglinide, repaglinide | Increase insulin secretion | Moderate | Continue regular use | Omit dose |
Alpha glucosidase inhibitors | Acarbose | Slow intestinal carbohydrate absorption | Low | Continue regular use | Omit dose |
Dipeptidyl peptidase-4 inhibitors | Sitagliptin, saxagliptin | Glucose-dependent increase in insulin section and decrease in glucagon secretion | Low | Continue regular use | Continue regular use |
Glucagon like peptide-1 analogs | Exenatide, liraglutide | Glucose-dependent increase in insulin secretion | Low | Continue regular use | Omit dose |
Sodium glucose co transporter-2 inhibitors | Dapaglifozina, canagliflozin | Decreases glucose reabsorption by the kidney | Low | Omit dose | Omit dose |
Long acting basal insulin | Lavemir, Lantus | Â | Low | Take 75% of dose | Take 50% of dose |
Mixed insulin; combination of long and short acting, i.e., 70/30 or 75/25 |  |  | Moderate to high | Take 75% of dose | If morning blood glucose is a. > 200 mg/dL take 50% of dose, b. ≤ 200 mg/dL omit dose |