25/08/2026
Medical Pearls:
SGLT2 inhibitors should be stopped preoperatively because of the risk of euglycemic DKA.
π₯ Preoperative SGLT2 rule
Dapagliflozin (Forxiga): stop β₯3 days before surgery
Empagliflozin (Jardiance): stop β₯3 days before surgery
Canagliflozin (Invokana): stop β₯3 days before surgery
Ertugliflozin (Steglatro): stop β₯4 days before surgery
Easy memory:
π Most SGLT2 inhibitors = 3 days
π Ertugliflozin = 4 days
β οΈ Postoperative
Do not restart automatically after surgery. Restart only when the patient is clinically stable, eating and drinking normally, adequately hydrated, and without ketosis/DKA risk.
Pearl: Normal glucose does NOT exclude SGLT2-associated euglycemic DKA.