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Patient Guidelines for Diabetes Medication Adjustment for Short Procedures

When undergoing surgery or another medical procedure, here are some important things you should consider about medication and/or insulin.

Diabetes pills or non-insulin injectable medications

(Symlin, Byetta/ Bydureon, Victoza, Trulicity or Ozempic)

  • During a clear liquid diet: stop diabetes medication other than insulin (see below for specifics on insulins).  Use glucose-containing clear liquids as needed to maintain blood sugar, not just diet beverages.
  • Other than insulin, do not take diabetes medication on the morning of your procedure.

Basal insulins and basal combination products

(Lantus, Levemir, Basaglar, Tresiba, Soliqua or Xultophy)

  • During a clear liquid diet: take 2/3 of your usual basal dose for a colonoscopy or similar procedures. Use glucose-containing clear liquids as needed to maintain blood sugar, not just diet beverages.
  • Morning of the procedure: take 2/3 of your usual morning basal dose.  Evening of the procedure, take your usual dose.

NPH insulin

(Novolin or Humulin N) For mixed insulins 70/30 or 75/25 ask your provider

  • During a clear liquid diet: take 1/2 dose of usual N insulin dose for colonoscopy or similar procedures. Use glucose-containing clear liquids as needed to maintain blood sugar, not just diet beverages.
  • Morning of the procedure: take 1/2 dose of usual N insulin dose.  For mixed insulins, omit the morning dose, take 1/2 dose when eating well.

Bolus insulin: Injections 

(Humulin, Novulin R, Humalog, NovoLog, Apidra or Fiasp)

  • Do not take usual doses of these fast-acting insulins while NPO (when told to withhold food and fluids) or on clear liquids.
  • You may require supplemental fast-acting insulin for blood sugars over 200. If you have a blood glucose correction scale use 1/2 usual doses to correct high blood sugars.

Bolus insulin: Insulin Pump

  • During a clear liquid diet: set a temporary basal rate of 65% for a colonoscopy or similar procedures. Use glucose-containing clear liquids as needed to maintain blood sugar, not just diet beverages.
  • Morning of the procedure: set a temporary basal rate of 65%.
  • For high blood sugar: use only 50% of recommended bolus dose with a blood sugar target of 120-180 mg/dl.

When to resume your normal doses

Go back to your usual medications after the procedure when you are eating normally.