What to do with your medication for your diabetes, diet and bowel preparation medication

Information for patients with diabetes taking ‘insulin’ or ‘insulin and tablets’ or ‘tablets and other injectable treatments ’ for Lower Gastrointestinal Endoscopy Procedures

MORNING & AFTERNOON appointment (no later than 2pm).

This information advises you on how to prepare in the days leading up to your endoscopy procedure, either colonoscopy, sigmoidoscopy or enteroscopy.
It will help you understand;

• What to do with your medication for your diabetes
• When to take your bowel preparation
• The required alterations to your diet to make sure your bowel preparation works and maintain your blood sugar levels

You should;

• Have received an appointment in the morning or no later than 2pm in the afternoon-contact endoscopy if you have not
• DO NOT DRIVE to or from the hospital due to the possibility of low blood glucose readings Check your blood glucose reading before leaving home if possible
• Bring your diabetes tablets with you.
• Bring your blood glucose monitor with you (if you have one)

If you have any questions or concerns;

• Please contact the Endoscopy Unit between the hours of 8am - 6pm

Please follow the actions below starting:

• 7 days before the day of your appointment if you take iron medications or day 4 before for all other patients.

Seven days before the procedure

If you are taking iron tablets please stop taking them, but continue all other medications including laxatives.

Four days before the procedure

If you are taking any constipating agents (e.g. loperamide, codeine phosphate etc.) stop taking them. Continue with all other medications until your appointment.

Three days before the procedure

Start following low fibre diet advice in the table below for your meals and continue following low fibre diet advice until you start taking your bowel prep medication the evening before your procedure. For the best results in cleansing the bowel a low fibre diet is advised. Eating other foods may affect how well the bowel preparation works to ensure good views of your bowel during your procedure.

Low Fibre Foods Allowed	High Fibre Foods NOT allowed
White meat, including skinless chicken, grilled or poached fish	Red meats, bacon, sausages or pies, black pudding
White bread, toast, pasta, rice, noodles or boiled or mashed potatoes (no skins)	Breakfast cereals
Cheese, Eggs boiled or poached, Tofu	Wholemeal or seeded bread, wholemeal pasta or brown rice
Ice Cream, custard, clear jelly (NO red or blackcurrant), boiled sweets	Fruit, Vegetables or salad
Butter/margarine	Deep fried or roasted potatoes, potato skins or chips
Shredless marmalade or clear jam (no bits)	Nuts, pulses, lentils, beans
Clear soups	Chocolate, Cakes, Yoghurts, Cream
Rich tea Biscuits or similar plain biscuit	No other Biscuits than specified in foods allowed
Water, Tonic water, black tea or coffee sugar or sweetener	Milk
*Soft drinks (non fizzy) including squash (no red or blackcurrant) ^Clear fruit juices without pulp/bits examples clear apple or white grape	Fresh orange or juices with pulp Alcohol
Bovril	Crisps

 

The day before the procedure

Breakfast and Lunch as usual using foods from low fibre diet allowed list

• Take your usual diabetes tablet(s).
• Take your usual dose(s) of insulin.
• Take your usual injection of Exenatide (Byetta®) or Liraglutide (Victoza®) or Lixisenatide (Lyxumia ®).
• Take your usual once weekly injection of Semaglutide (Ozempic®), Dulaglutide (Trulicity®), Exenatide (Bydureon®).

Tea-Time (Evening Meal) to be completed by 4pm-light meal using foods from low fibre diet allowed list

Following your tea-time meal even if you are hungry, do not eat any solid food after 4pm because this may affect how well your bowel prep works. Your bowel must be completely empty to ensure we have clear views during your endoscopy procedure.

You may drink clear fluids throughout the day. This should preferably be water, but you can also have tonic water, tea or coffee without milk, soft drinks (non-fizzy) including squash (no red or blackcurrant), Bovril, clear fruit juices without pulp/bits, for example clear apple juice.

^ Avoided clear fruit juices unless your blood glucose level is low.

Your diabetes medications with your evening meal

If you normally take tablet(s) at this time, do not take them.

Guidance on injection treatments

If you take rapid acting insulin i.e. Novorapid® Fiasp® (Aspart) Humalog® (Lispro), LyumjevTM(lispro –aabc), Apidra® (Glulisine) take HALF (1⁄2) your usual dose.

If you are carbohydrate counting continue as usual.

If you are on a twice-daily regimen take half (1⁄2) your usual dose.

If you are on a three-times daily regimen take half (1⁄2) your usual dose.

If you take long acting insulin i.e. Levemir® (Determir) or Lantus® Toujeo® or Semglee® or Abasaglar® (Glargine) or Tresiba® (Degludec) take your usual dose
at your usual time.

Do not take you usual injection of Exenatide (Byetta®) or Liraglutide (Victoza®) or Lixisenatide (Lyxumia ®).

Postpone taking your once weekly injection of Semaglutide (Ozempic®), Dulaglutide (Trulicity®), Exenatide (Bydureon®) until after the procedure if you usually take this on the same day as the procedure.

Monitoring is important

Check your blood glucose every 2-4 hours if possible.

If you are feeling unwell and/or your blood glucose is over 15mmols check for ketones (if you have been given ketostix or have a blood ketone meter and have been shown how to use them.

Contact the Endoscopy Centre or out of hours telephone number provided in your endoscopy information folder).

If your blood glucose is 4mmols or below. Follow treatment for hypoglycaemia guidance below.

Hypoglycaemia guidance

If any of your blood glucose readings are low (below 4 mmol/l), or you feel
‘hypo’ at any time:

• Have a cup of FLAT Lucozade (170mls)

or

• One 60ml bottle of LIFT drink (lemon & lime)

or

• 6-7 Dextrosol or Lucozade energy tablets

or

• 5 Glucotabs

It is advisable to avoid fizzy drinks as this may affect your endoscopy.
Re-check your blood glucose after 15 minutes and if your blood glucose remains less than 4 mmol/l then repeat this treatment.

Once you feel better you will need to follow it up with longer acting carbohydrate foods.

Choose one of the following:

2 - 3 Rich Tea or Marie biscuits or 1 slice of white bread.

If your blood glucose remains low despite this treatment for over 30 minutes, please seek medical advice

7pm

Make up your first dose of bowel preparation

Follow the instructions in the bowel preparation information. Drink as directed along with the additional fluids advised.

You should not eat any further solid food until after your procedure (unless you are needing to follow hypoglycaemia guidance).

However, you may drink clear fluids throughout the day. This should preferably be water, but you can also have tonic water, tea or coffee without milk, soft drinks (non fizzy) including squash (no red or blackcurrant), Bovril, clear fruit juices without pulp/bits, for example clear apple juice.

^Avoid clear fruit juices unless your blood glucose level is low.

The day of your procedure

Do NOT eat any solid food until after your procedure.

You may take clear fluids up to 2 hours before the time of your procedure preferable water.

No later than 5 hours before you procedure appointment time:

• Make up the second dose of your bowel preparation
• Even if this means you getting up early

The second dose of bowel preparation should be made up in the same way as the first.

Start drinking the bowel preparation at least 5 hours before the appointment time of your endoscopy procedure. Drink as directed along with the additional fluids using the guidance in the bowel preparation information.

For example if your appointment is:

• 9am you need to take your bowel preparation at 4am
• 10am you need to take your bowel preparation at 5am
• 2pm you need to take your bowel preparation at 9am

Continue to check your blood glucose every 2-4 hours if possible.

If you are feeling unwell and/or your blood glucose is over 15mmols check for ketones (if you have been given ketostix or have a blood ketone meter and you have been shown how to use them. Contact the Endoscopy Centre or out of hours telephone number provided in your endoscopy information booklet.

If your blood glucose is 4mmols or below. Follow treatment for hypoglycaemia as above.

Your diabetes treatment

Morning

• Do NOT take any tablets for your diabetes.
• If you take rapid acting insulin i.e. Novorapid®, Fiasp ® (Aspart),
• Humalog® (Lispro), LyumjevTM(lispro –aabc), Apidra® (Glulisine) do not take this.
• If you are on a twice-daily regimen take half (1⁄2) your usual dose.
• If you are on a three-times daily regimen take half (1⁄2) your usual dose.
• If you usually take long acting insulin in the morning i.e. Levemir®
• (Determir) or Lantus® or Toujeo® or Semglee® or Abasaglar® (Glargine) or
• Insulin Degludec (Tresiba®) take your usual dose.
• Do NOT take Exenatide (Byetta®), Liraglutide (Victoza®) or
• Lixisenatide (Lyxumia® ) on the morning of the procedure.
• Postpone taking your once weekly injection of Semaglutide (Ozempic®), Dulaglutide
• (Trulicity®), Exenatide (Bydureon®) until after the procedure if you usually take this on the same day as the procedure.

If you have an afternoon appointment:

At Lunchtime

• Do not take any tablets for your diabetes.
• If you take rapid acting insulin i.e. Novorapid® Fiasp ® (Aspart) Humalog® (Lispro), LyumjevTM(lispro –aabc), Apidra® (Glulisine) do not take this.
• If you are on a three-times daily regimen take half (1⁄2) your usual dose.
• If you usually take long acting insulin at lunch time i.e. Levemir® (Determir) or Lantus® or Toujeo® or Semglee® or Abasaglar® (Glargine) Insulin Degludec (Tresiba®) take your usual dose.

Check your blood glucose before leaving home. If your blood glucose is below 4mmol/l, follow the instructions on how to treat hypoglycaemia above.

On arrival at the Endoscopy Centre

When you arrive at the Endoscopy Centre your blood glucose will be checked and monitored by the nurse looking after you.

After your procedure

You will be given something to eat and drink unless the endoscopist has indicated otherwise. Your blood glucose will be checked before going home from the Endoscopy Centre.

If your appointment was before 10am

• If you are on a twice-daily insulin regimen take two thirds (2⁄3) of your usual morning dose with your post procedure food.
• If you are on a three-times daily regimen take your usual lunch-time dose.
• If you are on a four-times daily insulin regimen take your usual lunch-time dose.
• Continue your usual insulin regimen with your evening meal.
• If you also take tablets for your diabetes take these with your evening meal as usual.
• If you take an injection of Exenatide (Byetta®) or Liraglutide (Victoza®) or
• Lixisenatide(Lyxumia®) restart your injections the day after your procedure.
• If you usually take your dose of once weekly injections of Semaglutide (Ozempic®),
• Dulaglutide (Trulicity®), or Exenatide (Bydureon®) on the day of your procedure please take this after the procedure or when you get home.

Resume your normal diet after going home
and
Resume your usual diabetes treatment with your evening meal.

If your appointment was after 10am

DO NOT take your usual lunchtime diabetes medication

Resume your normal diet after going home
and
Resume your usual diabetes treatment with your evening meal.