Are you using medication for diabetes mellitus? In addition to our general blog on diabetes and eyelid corrections, it is also important to know which specific medication you use, as some diabetes medicines require extra attention around a surgical procedure.
Which medication does this concern?
- Metformin, the most commonly used tablet for type 2 diabetes
- Sulfonylurea derivatives: gliclazide, glimepiride (risk of too low blood sugar when fasting)
- SGLT2 inhibitors: empagliflozin (Jardiance), dapagliflozin (Forxiga), canagliflozin
- GLP-1 agonists: semaglutide (Ozempic, Rybelsus), liraglutide (Victoza); see also our separate blog on this
- Insulin: all forms (short-acting, long-acting, mixed forms)
Why is this relevant?
Well-controlled blood sugar levels are important for wound healing [1]. But fasting for a short time or an irregular eating pattern around the procedure can also affect your blood sugar, depending on which medication you use.
Sulfonylureas and insulin can cause low blood sugar (hypoglycaemia) during fasting or with an irregular eating pattern. The dosage sometimes needs to be adjusted temporarily for this, in consultation with your treating doctor.
SGLT2 inhibitors (such as Jardiance and Forxiga) require extra attention, because in rare cases they can cause so-called 'euglycaemic ketoacidosis'. This is a serious disturbance of blood sugar regulation that can occur without the blood sugar itself being very high. The known risk factors for this are mainly prolonged fasting, a greatly reduced food intake, and major or demanding operations (often under general anaesthesia) [2,3].
A eyelid surgery at Kliniek het Bolwerk is carried out under local anaesthetic: you do not need to fast and can simply continue your food, drink and medication according to your normal schedule. As a result, the main risk factors for euglycaemic ketoacidosis are largely absent. Research accordingly shows that the risk with elective, short procedures is considerably lower than with major operations: in a large series, euglycaemic ketoacidosis occurred in 0.17% of elective procedures, compared with 1.1% of emergency operations, and almost all cases involved people with diabetes who also used insulin and who had been fasting (for a prolonged period) [3].
If in doubt, or if you use insulin in addition to an SGLT2 inhibitor or generally feel unwell, we will still discuss this with your treating doctor [2,3].
Discuss it in a personal consultation with plastic surgeon David Jairath, at our clinic for eyelid surgery in Haarlem. A first consultation can usually take place within a week.
Our protocol at Kliniek het Bolwerk
1. Complete medication inventory
We ask you about all your diabetes medication, including insulin schedules and the times at which you use these.
2. SGLT2 inhibitors and insulin: simply keep eating
Because an eyelid correction takes place under local anaesthetic and you do not have to fast, you can, as a rule, simply continue to use SGLT2 inhibitors (such as Jardiance, Forxiga), as long as you keep eating and drinking normally [2,3]. Do you also use insulin, or do you feel unwell around the procedure (for example nauseous or with less appetite)? Then we consult, if necessary, with your GP or internist about a possible temporary adjustment [2,3].
3. Practical arrangements
We make clear arrangements about when you take your medication, what and when you eat and drink prior to the procedure, and how you measure your blood sugar [1].
4. Careful follow-up check
We pay extra attention to signs of a disrupted blood sugar after the procedure.
Important: are you using an SGLT2 inhibitor (Jardiance, Forxiga, or comparable)? Report this, but because an eyelid correction takes place under local anaesthetic and you do not have to fast, routinely pausing this medication is usually not necessary, as long as you simply keep eating and drinking. Do you also use insulin, or do you feel unwell? Then discuss this with your doctor.
When do we advise against the procedure (for the time being)?
- In the case of a strongly disrupted blood sugar level (very high or low values) without recent medical supervision [1]
- In the case of use of SGLT2 inhibitors in combination with insulin and a reduced food intake, illness or vomiting around the procedure, without consultation with the treating doctor [2,3]
- If your GP or internist advises against the procedure at this time
Our advice
Are you using medication for diabetes? Bring a complete medication overview to the intake consultation at Kliniek het Bolwerk, including insulin schedules. This way we can draw up a safe plan together with you, and, if necessary, your doctor.
Literature references
The publications below form the medical-scientific basis of this article:
- Upper Eyelid Blepharoplasty. StatPearls, NCBI Bookshelf. 2023. https://www.ncbi.nlm.nih.gov/books/NBK537078/
- Should glucagon-like peptide 1 receptor agonists be withheld during the preoperative period? Cleveland Clinic Journal of Medicine. 2025. https://www.ccjm.org/content/92/4/209
- Risk of perioperative discontinuation of SGLT2 inhibitors. British Journal of Anaesthesia. 2024. https://www.bjanaesthesia.org.uk/article/S0007-0912(24)00272-1/fulltext
