Diabetes and Surgery Abroad: Planning Around Blood Sugar

Short answer: many people with type 1 or type 2 diabetes have surgery safely, including abroad, but it takes more planning than usual. The core questions are whether your blood sugar is controlled well enough for your procedure, who will adjust your insulin or tablets around fasting, and how you'll manage highs and lows while recovering in an unfamiliar city.

This guide walks through the conversations to have before you book, what to pack, and how to plan the recovery days so diabetes is a managed risk rather than a surprise.

Why blood sugar matters for surgery

Surgery is a stress on the body. Stress hormones, anesthesia, pain, reduced activity and changes in eating all push blood sugar around, sometimes up, sometimes down. At the same time, high blood sugar is associated with a higher risk of wound infection and slower healing. For cosmetic procedures with long incisions or large areas of lifted skin, such as tummy tucks or body lifts, healing quality is a big part of the result.

None of this means you can't have surgery. It means your team needs to know about your diabetes in detail, and your plan needs to cover the full arc: the weeks before, the fasting period, the operating room, and recovery in a place where you may not have your usual routine, foods or support.

Your A1c: the conversation to have first

Your A1c (hemoglobin A1c, called hemoglobina glicosilada in Colombia) reflects your average blood sugar over roughly the past few months. Many surgeons look at it when deciding whether to proceed with elective surgery and when to schedule it.

We're deliberately not giving you a cutoff number. Thresholds vary by surgeon, procedure and individual health, and an A1c alone doesn't tell the whole story. What matters is that the people responsible for your care have actually looked at it and agree. Ask:

• Does my surgeon want a recent A1c result, and how recent?
• Is my current A1c acceptable for this specific procedure? If not, what would need to change, and should I postpone?
• Does my home doctor agree this is a good time to have elective surgery?
• Are there diabetes complications (kidney function, circulation, neuropathy, heart health) that change the plan or need their own clearance?

If your control isn't where it needs to be, postponing an elective procedure is a reasonable decision, not a failure. Booking flights and deposits around a date before you know the answer is the bigger risk. Our guide to pre-operative clearance covers the broader work-up.

Who adjusts your medications around fasting

Before surgery you'll be asked to fast. For someone on insulin or certain tablets, fasting without a dose adjustment can cause low blood sugar, while stopping medication without a plan can cause high blood sugar. Some drugs also need to be paused days in advance. The single most useful thing you can do is get a written, medication-by-medication plan before you travel.

A note on SGLT2 inhibitors

SGLT2 inhibitors are a class of diabetes medication that includes canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. In 2020, the FDA approved label changes advising that these drugs be stopped before scheduled surgery, at least three days beforehand for most of them and at least four days for ertugliflozin, because of the risk of a serious complication called ketoacidosis, which can occur even when blood sugar isn't very high. Some people take these medications for heart or kidney conditions rather than diabetes, and the same question applies. Confirm the exact timing with your prescriber and anesthesiologist rather than acting on this summary.

GLP-1 medications such as semaglutide raise a separate anesthesia question about stomach emptying, which we cover in detail in GLP-1 medications before surgery abroad.

CGMs, pumps and the operating room

Continuous glucose monitors and insulin pumps have changed diabetes care, but operating rooms and imaging departments have their own rules. Some devices may need to be removed or protected during certain imaging, and surgical equipment such as electrocautery can matter too. Device makers publish guidance on this, and hospitals have their own protocols. Ask well before surgery day, not in the pre-op bay.

• Can I keep my CGM on during surgery, and will anyone read it?
• Is the sensor site away from the surgical area and from where garments or binders will sit?
• If my pump comes off, who will manage my insulin and how?
• Will I need imaging (X-ray, CT, MRI) before or after surgery, and what does my device maker say about it?
• Who reconnects my pump or restarts my usual routine afterward?
• Do I have spare sensors and pump supplies in case one is removed or fails?

Traveling with supplies

Medical supplies can be hard to replace quickly in another country, especially specific insulin brands or device consumables. Plan as if you won't be able to buy anything locally.

1. Pack extraBring more than you expect to need: insulin, pen needles or syringes, test strips, sensors, pump supplies, glucose meter and batteries, plus a backup meter if you use a CGM.
2. Keep it in your hand luggageInsulin should not go in checked baggage, where it can be lost or exposed to extreme temperatures. Split supplies between two bags if you travel with a companion.
3. Bring a letterAsk your prescriber for a letter listing your diagnosis, medications and devices. It helps at security and with Colombian clinicians.
4. Make a bilingual listWrite each medication with generic name, dose and timing in English and Spanish. Colombian brand names may differ from yours.
5. Plan for storageAsk whether your recovery lodging has a fridge you can use, and bring an insulated pouch for days out.
6. Pack hypo suppliesCarry fast-acting glucose in every bag, and check whether glucagon is right for you.

Managing highs and lows during recovery

Recovery is where people with diabetes are often left on their own: back in an apartment or recovery house, sore, sleeping at odd times, eating less or differently, and possibly taking new medications. Pain and stress can push glucose up; reduced appetite and nausea can push it down. Some medications given around surgery, such as steroids used for nausea or swelling, can raise blood sugar too.

• Check more often than at home for the first days, and keep a simple log your team can read.
• Agree on numbers with your surgeon and home prescriber: at what reading do you call, and whom?
• Have easy food on hand that fits your plan, including something for lows that you can manage while lying down.
• Brief your companion on recognizing and treating hypoglycemia, and where your glucose and glucagon are kept.
• Watch wounds closely. Increasing redness, warmth, swelling, discharge or fever needs prompt attention. Our guide on infections after surgery abroad explains why early reporting matters.

Choosing a procedure, team and city with diabetes in mind

Diabetes should shape your choices, not just your packing list. A few things worth weighing:

• Procedure size. Larger or combined procedures mean longer anesthesia, more healing tissue and a longer recovery. Ask whether staging makes more sense for you.
• Overnight monitoring. Ask whether you'll stay in a facility overnight where glucose can be checked and treated, rather than going straight to lodging.
• Who manages diabetes in hospital. Ask whether an internist or endocrinologist is available if your sugars are hard to control.
• Length of stay. Plan enough time locally for wound checks before you fly, with flexibility if healing is slower.

Frequently asked questions