Table 1.

Oral and injectable antihyperglycemic agents—preoperative management

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 eGFR < 60 ml/min/1.73 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		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