The anesthesia provider must balance the risk of hypoglycemia and hyperglycemia. Previous practice patterns involved discontinuing all non‐insulin hypoglycemic agents day of surgery (and multiple doses of metformin), but this practice is evolving
For medications held/discontinued, many can be restarted postoperatively once the patient is eating/drinking
If discontinued, able to proceed without supplementation
Previous anesthetic concerns were that metformin and NPO coupled with decreased renal excretion could increase risk of lactic acidosis, but this is no longer as extensive as a threat as once thought [39]
