Management of Diabetes Medications Before Colonoscopy
For a colonoscopy, Jardiance (empagliflozin) should be held on the day of the procedure, while Januvia (sitagliptin) can be continued, Lantus (insulin glargine) should be reduced but not completely discontinued, and Glipizide should be held on the day of the procedure to minimize hypoglycemia risk. 1, 2
Medication-Specific Recommendations
SGLT-2 Inhibitors (Jardiance/Empagliflozin)
- Hold Jardiance on the morning of colonoscopy to avoid potential dehydration and electrolyte imbalances during bowel preparation 2
- Resume Jardiance after the procedure once normal eating has resumed and kidney function has been verified 2
DPP-4 Inhibitors (Januvia/Sitagliptin)
- Januvia can be safely continued through the colonoscopy preparation period 1, 3
- Unlike GLP-1 receptor agonists, DPP-4 inhibitors do not significantly delay gastric emptying and do not increase risk of inadequate bowel preparation 1, 4
Long-Acting Insulin (Lantus/Insulin Glargine)
- Reduce Lantus dose by 20-25% the evening before colonoscopy to prevent hypoglycemia during the fasting period 5, 3
- Do not completely discontinue Lantus as this could lead to significant hyperglycemia and metabolic decompensation 5
- Studies show patients can safely undergo colonoscopy when long-acting insulin is adjusted rather than completely discontinued 5
Sulfonylureas (Glipizide)
- Hold Glipizide on the morning of colonoscopy due to high risk of hypoglycemia during fasting 3, 6
- Sulfonylureas stimulate insulin secretion regardless of blood glucose levels, creating significant hypoglycemia risk during the required fasting period 3
Timing Considerations
- For medications that need to be held, stop them on the morning of the colonoscopy 2
- For split-dose bowel preparation regimens, begin the second portion 4-6 hours before colonoscopy and complete at least 2 hours before the procedure 2
- Monitor blood glucose more frequently during the preparation period, especially during the fasting phase 2, 6
Risk Factors for Hypoglycemia During Colonoscopy Preparation
- Studies identify key risk factors for hypoglycemia during colonoscopy preparation: low C-peptide levels, insulin use, and type 1 diabetes 6
- Nocturnal hypoglycemia occurs in approximately 16% of diabetic patients during colonoscopy preparation 6
- Most hypoglycemic episodes during colonoscopy preparation are mild (Grade 1), but require monitoring 6
Post-Procedure Considerations
- Check kidney function before restarting SGLT-2 inhibitors like Jardiance, especially in high-risk patients 2
- Resume normal medication schedule once eating has resumed after the procedure 2, 3
- Return to pre-procedure insulin dosing once normal meals are resumed 5, 3
Common Pitfalls to Avoid
- Completely stopping long-acting insulin (Lantus) can lead to significant hyperglycemia and should be avoided 5, 3
- Failing to hold sulfonylureas (Glipizide) during fasting periods significantly increases hypoglycemia risk 3, 6
- Inadequate glucose monitoring during the preparation period can miss early hypoglycemia 2, 6
- Restarting SGLT-2 inhibitors (Jardiance) without verifying kidney function can increase risk of complications 2