Illness, Surgery, and Diabetes Meds: What You Should Know

When you have diabetes, your medications are a key part of staying healthy. However, sometimes when you are sick or need surgery or a medical procedure, your body may react differently to these medications.

In this article, we'll outline clear information about common diabetes medicines and what to consider when you are not feeling well. You will learn important questions to ask your healthcare team to keep you safe.

Stay hydrated

The golden rule for managing your diabetes when you are sick is to stay hydrated. You must drink many fluids. You will probably need a mix of fluids that have no sugar and fluids that have carbohydrates (sugar), especially if you cannot eat solid food. A fever, diarrhea, or vomiting can cause dehydration. Dehydration can make your blood sugar run higher.

In some cases, if you become too dehydrated, your kidneys may have trouble working well. If your kidneys struggle, your body may have trouble getting rid of some of your medications. Your doctor may tell you to stop taking your medication for a short time to keep your kidneys safe.

Talk with your doctor

It is very important to have clear instructions about your diabetes medications when you are sick or getting ready for a procedure. Getting clear instructions can help prevent you from needing to go to the hospital, having a delayed or canceled procedure, or having blood sugar problems (like highs or lows).

Make sure you understand what to do with your diabetes medications if you have a planned surgery or procedure. Talk with your provider about what to do on days when you feel sick.

Here are a few questions to ask your healthcare team:

• Should I stop any of my medications if I cannot eat or drink anything (because I am sick or fasting for a procedure)? If so, when should I start taking those medications again?
• What can I use to treat low blood glucose if I am fasting for a surgery or procedure?
• What over-the-counter medications can I use for my illness (like cold medicine or pain relievers)?
• What symptoms and blood glucose levels should make me call you right away when I am ill?

Understand your specific medications

The information below is general information about common diabetes medications. You must use this information to talk with your provider and create a sick-day and surgery plan that is just for you.

Metformin

Metformin can cause upset stomach, nausea, or diarrhea for some people. Being sick may make these side effects worse. In addition:¹

• It is very important to stay hydrated and call your doctor if you cannot keep any fluids down.
• If your kidneys are struggling, you are at a higher risk for a serious problem called lactic acidosis.
• You may be asked to stop taking Metformin before surgeries or procedures to lower this risk.

Sulfonylureas and meglitinides

These groups of medications include names like glipizide, glyburide, glimepiride, repaglinide, and nateglinide. They have a risk of low blood glucose.²

If you are having trouble eating or drinking steadily, or if you must fast (not eat) for a surgery or procedure, you may be at a higher risk for lows. Ask your provider what you can use to treat a low blood sugar, especially if you are told to only have clear liquids before a procedure.²

GLP-1 agonists

These medications include brand names like Ozempic®, Rybelsus®, Trulicity®, Bydureon®, Victoza®, and Mounjaro® (Mounjaro® is a combination drug). These medications slow down your digestive tract. You may be asked to stop taking them before surgeries or procedures (like a colonoscopy) so that food can be fully cleared from your stomach and intestines.³

Common side effects include nausea, constipation, and, in some cases, diarrhea. Again, being sick may make these side effects worse. This means staying hydrated is always important when you are taking these medications, whether you are well or sick.³

SGLT-2 inhibitors

SGLT-2 inhibitors include brand names like Jardiance^®, Invokana^®, Farxiga^®, Steglatro^®, and Brenzavvy™. These medications help your body get rid of extra glucose (sugar) through your urine.⁴

Drinking extra fluids to stay hydrated is important when you are taking these medications, even when you are well. If you are fasting for a surgery or procedure, your provider may have you stop taking these medications for a few days until you are able to stay hydrated again.⁴

Some people who eat very low-carb diets, have had diabetes for a long time, or who also use insulin may be at risk for a serious condition called diabetic ketoacidosis (DKA). This risk may increase during an illness or other body stress.⁴

Final thoughts

Your diabetes medications are essential, but you must know how to adjust them when you are sick or having a medical procedure. The most important actions you can take are to stay hydrated and to talk clearly with your healthcare provider. Use this information to create a personal plan that will help you stay safe and healthy during times of illness or when preparing for surgery.