GLP-1 medicines before surgery or a procedure: what to tell the team

During general anaesthesia and deep sedation, protective airway reflexes are reduced. If the stomach still contains food or fluid, there is a small risk of it passing into the lungs, which can cause serious pneumonia. Fasting before procedures is designed to prevent this. Because GLP-1 medicines slow gastric emptying, some patients may still have residual stomach contents despite following fasting instructions. Cases have been reported, and professional bodies have issued guidance.

Initial recommendations in some countries advised stopping weekly injections for a week or more before elective procedures. Subsequent evidence and guidance from perioperative and anaesthetic organisations moved towards individual risk assessment, since stopping can disrupt diabetes control and may not be necessary for everyone. Approaches may include continuing the medicine with a modified diet, such as a liquid-only diet for a period before the procedure, or ultrasound assessment of the stomach on the day. Local policies differ, so follow your hospital's instructions.

• Starting treatment or increasing the dose recently, when gut effects are more marked.

• Symptoms such as nausea, vomiting, bloating or abdominal pain.

• Diabetes with gastroparesis or long-standing disease.

• Emergency or urgent procedures where fasting cannot be guaranteed.

• Procedures involving deep sedation, such as some endoscopies.

List all your medicines, including injections, at pre-assessment, with the date of your last dose. Ask the team in advance what to do about the injection and meals. Follow any special dietary advice, such as clear fluids the day before. If you feel nauseated or bloated on the day, say so honestly, because the team may delay or change the plan.

If you take a GLP-1 medicine for diabetes, stopping it or changing food intake before a procedure can alter your glucose. The hospital team should give a plan for other diabetes medicines, such as insulin or SGLT2 inhibitors, which have their own fasting rules. Ask for written instructions.

The same considerations apply for dental procedures under sedation and for cosmetic surgery under general anaesthesia. Surgeons and clinics should ask about these medicines and coordinate with an anaesthetist. If a provider does not ask, mention it yourself.

Bring your medicine list, note the date and time of your last injection and tell staff about any bloating, nausea or early fullness that morning. Ask whether you should take your other regular tablets. If instructions from different teams conflict, for example the surgeon and a diabetes nurse, ask the anaesthetist to resolve it before the day rather than guessing.