Introduction

Periprocedural management of noninsulin antihyperglycaemic drugs for a patient with type 2 diabetes depends on the:

• anticipated duration of fasting
• duration and complexity of the procedure
• expected postprocedure recovery (eg early return to normal eating and drinking, delayed return to oral intake due to vomiting or pain).

Drug dosage may need to be changed or a drug withheld temporarily. If a particular noninsulin antihyperglycaemic drug is withheld a day or more before the procedure (eg metformin), the dose of other antihyperglycaemic drugs may need to be increased until the day of the procedure. Insulin may be required if blood glucose concentrations are high (more than 12 mmol/L).

Ideally, before a procedure, patients with type 2 diabetes should be taught to self-monitor blood glucose concentrations (unless they already self-monitor). This allows the patient to identify hyperglycaemia or hypoglycaemia, which may occur if their usual medication is changed because of the procedure.