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Thus, convincing experimental evidence obtained from invertebrates and nonhuman vertebrates taught us that down-regulated IIS is of critical importance for metabolic homeostasis, improved oxidative stress responses and longevity

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" "For patients diagnosed with diabetes mellitus on a very low energy/liver reduction diet for the purposes of surgery, sodium-glucose cotransporter-2 inhibitors should be stopped at commencement of the diet, and adjust diabetes mellitus treatment as necessary." "Written sick-day rules should be provided to patients at pre-operative assessment and at discharge." 3.5 Comparison with Other Guidelines: 3.5.1 American Heart Association (AHA) Guidelines [4] : "In patients scheduled for NCS, SGLT2i should be discontinued 3 to 4 days* days before surgery to reduce the risk of perioperative metabolic acidosis (COR I/LOE C-LD) *Canagliflozin, dapagliflozin, and empagliflozin should be stopped 3 days and ertugliflozin 4 days before scheduled surgery." 3.5.2 European Society of Cardiology (ESC) Guidelines [5] : "It should be considered to interrupt SGLT-2 inhibitor therapy for at least 3 days before intermediate- and high-risk NCS." (Class IIa/Level C) 3.5.3 ESAIC Guidelines [3] : "R12.8: SGLT2 inhibitors (SGLT2i) drugs should be withheld for 3 to 4 days before elective procedures to reduce the risk of euglycemic diabetic ketoacidosis

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