skip to main content

Peri-operative diabetes management — SCE Endocrinology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateDiabetes mellitusPeri-operative diabetes managementSCE Endocrinology

A 56-year-old man with type 2 diabetes is listed for elective colectomy. HbA1c is 67 mmol/mol and he takes metformin, empagliflozin and gliclazide. He is placed on a pre-operative very-low-calorie diet and will fast overnight. What is the most appropriate medication advice?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Stop empagliflozin before surgery and monitor ketones if unwell

Stop empagliflozin before surgery and monitor ketones if unwell is best because SGLT2 inhibitors should be withheld before major surgery or prolonged fasting because of euglycaemic ketoacidosis risk. The alternatives are less appropriate because continuing or increasing empagliflozin is unsafe; gliclazide increases fasting hypoglycaemia risk; pioglitazone is not a peri-operative substitute. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: JBDS-IP peri-operative diabetes guideline