6 questions about diabetes before orthopedic surgery

1. Ask what needs attention before the operation

Bring recent glucose information, relevant laboratory results and your current treatment list. Tell the team about low-glucose episodes, kidney or heart problems, changes in sensation and previous healing difficulties. Diabetes can affect infection and healing risk, but the preparation should be individualized. Ask which findings matter for this operation, whether another assessment is needed and what would lead to delaying an elective procedure. You should understand the reason for any target or request rather than trying to satisfy a number without a plan.

If additional preparation is recommended, ask who will help make it achievable and when progress will be reviewed. That might mean coordinating with the clinician who normally manages diabetes, reviewing access to medicines or obtaining a clearer monitoring record. The discussion should distinguish a modifiable concern from a blanket refusal based on a diagnosis. Ask what would make the team comfortable proceeding and how the urgency of the orthopedic problem affects the balance, so the next steps are understandable and connected to your circumstances.

Sources: Preparing for surgery when you have diabetes

2. Get an individualized medicine plan

Insulin and different noninsulin medicines can require different perioperative instructions. Ask what to take, adjust or hold and who has coordinated that decision with the prescriber. Tell the anesthesia team about SGLT2 inhibitors, GLP-1 medicines and any other treatment they ask about. Do not use one generic rule for every diabetes medicine or stop insulin independently. Obtain the plan in writing, including what to do if the operation time changes or you are unsure about a dose.

Sources: Preparing for surgery when you have diabetes · American College of Surgeons — Medication and Surgery

3. Coordinate fasting and glucose monitoring

Ask when monitoring should occur, who checks glucose at the facility and what readings or symptoms should prompt contact before arrival. Discuss pumps and continuous glucose monitors explicitly; the team needs to decide how they will be managed during the procedure. Clarify the eating and drinking instructions and what to do if you develop low glucose while fasting. The answer should come from the clinicians responsible for your care, with a contact route for questions rather than an expectation that you improvise.

Sources: Preparing for surgery when you have diabetes

4. Plan for changed eating and activity afterward

Pain, nausea, reduced activity and the stress of surgery can alter glucose management. Ask how the medicine plan will adapt if you cannot eat normally and who will review the readings after discharge. Arrange appropriate food and help obtaining supplies. If you live alone or have difficulty seeing labels or using devices, raise that before surgery. A plan that assumes your normal routine continues unchanged may not fit the first recovery phase.

Sources: American College of Surgeons — Strong for Surgery

5. Connect wound care with the diabetes plan

Ask which wound changes and general symptoms need prompt assessment, and who handles those concerns outside office hours. Keep the dressing instructions and glucose plan together so a helper can understand both if you authorize their involvement. Tell the team if limited mobility or a shoulder restriction prevents you from checking the incision or managing your usual device. The answer may require practical assistance, not just more written instructions. Report concerns rather than treating delayed healing as an inevitable consequence you must accept.

Sources: American College of Surgeons — Strong for Surgery

6. Agree on the handoff back to usual care

Before discharge, identify which medicines changed temporarily, who gives restart instructions and when your regular diabetes clinician should hear from you. Ask for the current list to be shared with the relevant offices. If the plan involves a new prescription or different dose, confirm access and cost. At Commons Clinic, tell us who manages your diabetes so orthopedic preparation can account for that relationship. Patient accounts about coordination may help you choose a consultation, but your glucose history and operation determine the actual plan. Keep the current medicine instructions with your glucose records.

Sources: American College of Surgeons — Medication and Surgery

Sources & further reading

• Preparing for surgery when you have diabetesMedlinePlus / National Library of Medicine
• American College of Surgeons — Medication and SurgeryAmerican College of Surgeons
• American College of Surgeons — Strong for SurgeryAmerican College of Surgeons

We use these medical sources to help explain your options and prepare you for a conversation with our team. Our guides feature our own clinicians; patient reviews describe individual experiences.

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