Preparation for gastrointestinal procedures in adults with diabetes

Adults with diabetes who need an endoscopic gastrointestinal procedure are best managed in conjunction with their endocrinologist and/or diabetes education nurse. Ideally, they should be scheduled for an early morning procedure to avoid disruption of their normal routine. Advise these patients to take their insulin and other medications with them to the procedure. Some patients may need admission to hospital and close monitoring of their blood glucose concentration. For detailed information on the periprocedural management of patients with diabetes, including guidance on bowel preparation and fasting before a procedure, see Periprocedural management of adults with diabetes.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors (eg dapagliflozin, empagliflozin, ertugliflozin) have been associated with the development of euglycaemic diabetic ketoacidosis (DKA) in patients with diabetes, which can result in coma and deathMeyer, 2020. The risk is increased if the patient has been fasting, has very restricted dietary intake or has undergone bowel preparationMeyer, 2020. Stop SGLT2 inhibitors 2 days before the procedure, or strongly consider postponing nonurgent gastrointestinal procedures if the SGLT2 inhibitor was not stoppedMeyer, 2020. See SGLT2 inhibitors for comprehensive information on the periprocedural management of SGLT2 inhibitor therapy. Alerts highlighting the periprocedural risk of diabetic ketoacidosis in patients taking an SGLT2 inhibitor have been issued by the Australian Diabetes Society and the Australian Therapeutic Goods Administration.