In order to examine the whole of the bowel it must be clear of all waste materials. This is achieved by using a combination of changing what you eat and taking laxative medicines. Please follow the instructions printed below.
7 days before your Procedure please stop taking iron tablets.
2 days before your Procedure please stop taking any medicines, which may constipate you, for example Codeine, Co-phentrope (Lomotil), Kaolin and Morphine, loperamide (Imodium).
All other medication should be continued as normal unless otherwise instructed by the Specialist Screening Practitioner.
Two days before your test on ………………………………….please follow a low residue diet, which consists of the following:
Fats (use sparingly) Butter, Margarine.
Eggs Boiled, Poached
Cereals Crisped Rice cereal, Cornflakes (no bran)
Cheese Cream, cottage or Cheese sauce
Potatoes Boiled, Creamed, mashed or baked (no skins)
Plain boiled white rice
Meat / Fish Minced or well cooked, tender lean Beef, Lamb, Ham, Pork, Poultry, Fish, shellfish
Bread White bread / toast
Sugar / Sweetener White sugar, brown sugar, sweetener
Dessert Clear Jelly (no red coloured jelly)
Pasta Plain macaroni, Spaghetti Noodles
**** IMPORTANT: PLEASE DO NOT HAVE ANY FRUIT, VEGETABLES OR FOODS CONTAINING FIBRE. ****
Please note: If you have not passed wind or opened your bowels in the 5 days leading up to taking your bowel prep please contact the Specialist Screening Practitioner for advice at the Bowel Cancer Screening Programme office on 01253 953014 or 952855
Instructions for a Morning Appointment
• Please take any morning or afternoon medications at least two hours before taking your Picolax.
• Have a light breakfast from the low residue diet followed by a light lunch at between 12:00 – 13:00pm from the low residue diet.
• From 13:00pm do not eat any more solid food until after the procedure.
• You are advised to drink only clear fluids to include water, clear soup, Bovril, Oxo, strained fruit juice (not red-coloured), tea or coffee (without milk, soy or cream).
• At 3:00pm mix the first sachet of Picolax in a 150ml glass of water and stir for 2-3 minutes until the solution is an off-white cloudy liquid that is orange flavoured and drink all the solution. (Sometimes the solution becomes warm as the powder dissolves. If this happens, wait until it cools sufficiently before drinking it).
• After taking the first sachet, it is important that you drink at least five x 250ml drinks of clear fluids spread over several hours (this needs to be completed before taking the second dose of Picolax). Clear fluids should include a variety such as water, clear soup, Bovril, Oxo, strained fruit juice (not red-coloured), tea or coffee (without milk, soy or cream).
• At 7:00pm mix the second sachet of Picolax in a 150ml glass of water and stir for 2-3 minutes until the solution is an-off white cloudy liquid that is orange flavoured and drink all the solution.
• After taking the second sachet of Picolax, it is important to drink at least three x 250ml drinks of clear fluids before bedtime.
• It is essential to drink the recommended volume of clear fluids to remain hydrated and to ensure that the bowel is properly cleansed.
• Please do not eat any solid food but it is important that you continue to take clear fluids until 2 hours prior to the test.
• All other medication should be continued as normal unless otherwise instructed by the Specialist Screening Practitioner.
Instructions for An Afternoon Appointment
• Please take your morning medication at least two hours before taking your Picolax.
• You may have a light breakfast and lunch from the low residue diet followed by a light evening meal between 4:00pm–5:00pm from the low residue diet.
• From 5:00pm you are not to eat any more solid food until after the procedure.
• You are advised to drink a variety of clear fluids to include water, clear soup, Bovril, Oxo, strained fruit juice (not red coloured), tea or coffee (without milk, soy or cream).
• At 7:00pm mix the first sachet of Picolax in a 150ml glass of water and stir for 2-3 minutes until the solution is an off-white cloudy liquid that is orange flavoured and drink all the solution. (Sometimes the solution becomes warm as the powder dissolves. If this happens, wait until it cools sufficiently before drinking it).
• After taking the first sachet, it is important that you drink at least five x 250 ml drinks of clear fluids spread over several hours (this needs to be completed before taking the second dose of Picolax). Clear fluids should include a variety such as water, clear soup, Bovril, Oxo, strained fruit juice (no red-coloured), tea or coffee (without milk, soy or cream).
• It is essential to drink the recommended volume of clear fluids to ensure you remain hydrated and that the bowel is properly cleansed.
• Please take your morning medication at least two hours before taking your Picolax unless otherwise instructed by the Specialist Screening Practitioner.
• At 7:00am mix the second sachet of Picolax in a 150ml glass of water and stir for 2-3 minutes until the solution is an off-white cloudy liquid that is orange flavoured and drink all the solution.
• After taking the second sachet, it is important that you drink at least three x 250ml drinks of clear fluids up to two hours before your appointment.
• It is essential to drink the recommended volume of clear fluids to ensure you remain hydrated and that the bowel is properly cleansed.
Side effects can include nausea, vomiting, bloating, abdominal pain, anal irritation and sleep disturbance. Vomiting and severe diarrhoea can cause fluid loss (dehydration) leading to dizziness, headache and confusion if you don’t have proper fluid and salt replacement.
Some people are allergic to Picolax but this is rare. Symptoms of allergy include rash, itching, redness and swelling. If you experience any of these symptoms, please contact the Bowel Cancer Screening Programme Office on 01253 953014 / 952855 for advice. Out of hours please seek medical advice.
We do aim to give patients with Insulin Treated Diabetes a morning appointment and those taking non-insulin injectable therapies and/ or tablet controlled diabetes an early afternoon appointment. NB: If you are on Insulin Therapy and your appointment time is not prior to 11am, please contact the Bowel Cancer Screening Department on 01253 953014 / 952855 to reschedule for an earlier appointment time.
The necessary change in your diet may upset your diabetes. However, do not worry, as this will not cause any long-term harm. You may on the days leading up to your Colonoscopy be at risk of having a “hypo” (too low blood sugar).
Patients who are at risk of a potential low blood glucose can prevent this by taking a small quantity of a sugar containing drink if needed. It would be a good idea for you to monitor your blood glucose if this is likely to happen.
We aim not to admit patients during the 2-day preparation period before Colonoscopy unless their diabetes is particularly unstable, and we hope the enclosed directions are helpful.
Two days Before your Procedure:…………………………………… please take the low residue diet.
The low residue diet can be combined with your usual diabetes medication, but you need to make sure that you have either cereal, bread, potato, pasta or rice as allowed on the low residue diet with each meal. If you normally monitor your own blood glucose tests at home, then it would be a good idea to carry out blood glucose monitoring before meals while carrying out the 2 day bowel preparation.
If you have any concerns about managing your diabetes while preparing for this investigation, please contact the Diabetes Specialist Nurses below or the primary care team if they manage your diabetes care:
Patients within Greater Preston contact Preston (01772) 777621 or Chorley and South Ribble contact Chorley (01257) 245350 Monday-Friday 9am to 5pm.
For Patients within West Lancashire contact Ormskirk 0300 2470011 (option 5).
For patients within Blackpool Fylde and Wyre area, please contact 01253 953486 Monday – Friday 09:00am - 11:00am.
For patients within East Lancashire and Blackburn with Darwen, please contact 01254 735015.
Please follow the appropriate instructions depending if you have a morning or afternoon appointment as detailed on previous pages and follow the Diabetes advice specific to you as detailed on the following pages.
Instructions for Patients whose Diabetes is Treated with Non - Insulin Injectable Therapies and / or Tablets
For a morning appointment you will have had a low residue breakfast and lunch.
For an afternoon appointment you will have had a low residue breakfast, lunch and tea.
You must then drink only clear jelly, clear fluids such as glucose drinks, Bovril, clear soup, black tea or coffee (no milk), fizzy lemonade, coke or water.
Following administration of first sachet of Picolax no more of the following diabetes oral medications should be taken for the rest of the day:
• Glibenclamide
• Gliclazide or Glicazide MR
• Glimepiride
• Glipizide
• Gliquidone
• Repaglinide or Nateglinide
• Tolbutamide
• Pioglitazone
• Acarbose (Glucobay)
• Metformin (Glucophage or Glucophage SR)
• Sitagliptin (Januvia)
• Sitagliptin with metformin
• Vildagliptin (Galvus)
• Vildagliptin with Metformin
• Saxagliptin (Onglyza)
• Saxagliptin with Metformin
• Linagliptin (Trajenta)
• Linagliptin with Metformin
• Alogliptin (Vipidia)
• Alogpitin with Metformin
• Canagliflozin (Invokana)
• Canagliflozin with Metformin
• Dapagliflozin (Forxiga)
• Dapagliflozin with Metformin
• Empagliflozin (Jardiance)
• Empagliflozin with Metformin
• Ertugliflozin
• Rybelsus
• Exenatide (Byetta) twice daily
• Liraglutide (Victozia) once daily
• Lixisenatide (Lyxumia) once daily
Note: Once weekly preparations should be continued For example, Albiglutide, Dulaglutide and Exenatide modified release (Bydureon), Trulicity and Ozempic.
Blood Glucose Testing:
If you normally self-test using a blood glucose, it is advisable to check your blood glucose level regularly during the day prior to the investigation. Check the blood glucose by testing four–six hourly, or if you feel unwell, or if you feel hypo.
If your blood glucose goes below 4mmol/L, take 20 grams carbs = 220mls glass of Lucozade® or normal Coke or lemonade or six glucose tablets immediately.
Hypoglycaemia: The main symptoms of hypoglycaemia could be feeling sweaty, shaky, hungry, tired, dizzy, tingling on lips or anxiety/ palpitations.
Hypoglycaemia: a blood glucose below 4mmols should be treated with 20g carbohydrate, for example, six glucose tablets or 220mls glass of lemonade or coke or Lucozade. This should be repeated if the symptoms are not resolving, or the blood glucose is not rising after 15 minutes.
Due to the risk of a hypo-glycaemic episode (too low blood sugar), it is important that you do not drive yourself to and from the procedure if your blood glucose is below 5.0mmol/L.
• Test your blood glucose when you get up (if you normally do so). If below 4mmol, take 20g carbohydrate, for example, take six glucose tablets or 220mls glass of Lucozade®, lemonade or Coke (not low sugar). Check blood glucose 15 minutes later and if below 4mmols repeat taking the glucose tablets, full sugar lemonade or Coke.
• Do not take morning diabetes medications (as listed above) and breakfast.
• Clear fluids to be taken only, up to two hours before your appointment.
• Take along your diabetes medications and some food to your appointment, so that you can have your diabetes medications with some food after your investigation.
• On arrival, remind staff that you have diabetes
• Take your normal diabetes medications with a meal or when next due after investigation, except SGLT2 inhibitors (e.g. dapagliflozin, empagliflozin, canagliflozin). When you are feeling well and are eating and drinking normally you can restart SGLT2 inhibitors.
• Check your blood glucose before meals for the rest of the day if you normally self-test at home.
Instructions for Patients Treated with Insulin Therapy Alone or in Combination with other diabetes medications
For a morning appointment you will have had a low residue breakfast and lunch.
For an afternoon appointment you will have had a low residue breakfast, lunch and tea.
You must then drink only clear jelly, clear fluids such as glucose drinks, Bovril, clear soup, black tea or coffee (no milk), fizzy lemonade, Coke or water.
Sugar-containing drinks may be important to keeping the blood glucose from dropping too low. Take these in small quantities at regular intervals across the day and evening to keep the blood glucose stable.
• Test your blood glucose levels before administering insulin and more frequently if required.
• If you are confident about adjusting your insulin dose according to your reduced carbohydrate intake, and also substituting carbohydrate in clear liquid form (for example, lemonade, coke, Lucozade®), you are advised that frequent intake of small amounts (1/4 - 1/2 a glass) is required.
Insulin Therapy
If you are confident in adjusting your own insulin please follow the following advice:
Basal bolus regimens
• If you are taking Basal bolus regimens: Do not take the short acting insulin for example Novorapid, Humalog, Apidra, Fiasp during the fasting period. Take 80% of usual basal insulin dose (for example, Lantus, Levemir, Abasaglar, Toujeo, Humulin I).
Long-Acting Insulin Only or Mixed Insulin Regimes
• If you are taking a long-acting insulin only regime (e.g., Lantus, Levemir, Insulatard, Abasaglar, Toujeo, Humulin I) or a mixed insulin regime (for example Humulin M3, Humalog Mix 25, Insuman Comb 25 including other similar medications,) take the usual dose the day before procedure and during the fasting period.
If you are taking Hypurin / Porcine type, you are advised to contact your Diabetes Specialist Nurse.
• Morning long-acting insulin – take half normal dose if taking a long-acting-only regime. (for example, Lantus, Levemir, Abasaglar, Tresiba, Toujeo Humulin I, Insulatard; or Insuman Basal). Patients on a basal bolus regime should take 80% of their usual dose.
• Morning mixed insulin – take half normal dose (for example, Humulin M3, Humalog Mix 25, Insuman Comb 25 including other similar medications).
• Morning short acting insulin – Do not take your dose for example, Novorapid, Humalog, Apidra, Fiasp.
Please contact your Diabetes Nurse Specialist if you are taking Hypurin Porcine type insulin.
Please test your blood sugar when you get up (if you normally do so). If below 4mmol/L, take 20g carbohydrate, for example, six Glucose tablets or 220mls glass of lemonade or Coke (not low sugar), or a 220mls glass of Lucozade®. Check blood glucose 15 minutes later and if below 4mmols repeat taking the glucose tablets, full sugar lemonade or Coke.
Please take clear fluids up to two hours before your appointment.
Please take along your morning insulin and some food to the appointment, so your insulin can be given with some food after the investigation.
Please do not to drive to or from your appointment if on insulin.
Please remind staff that you have diabetes on arrival to the Endoscopy Unit.
If the District Nurse administers insulin in the morning, please bring along your Folder (yellow), insulin and syringe to the appointment.
• Check your blood glucose before meals for the rest of the day if you normally self-test at home.
• Resume insulin at normal times across the rest of the day with your normal diet.
If you have any concerns about managing your diabetes while preparing for this investigation please contact the Diabetes Specialist Nurses as below or the primary care team if they manage their diabetes care for advice:
Patients within Greater Preston contact Preston (01772) 777621 or Chorley and South Ribble contact Chorley (01257) 245350 Monday – Friday 9am to 5pm.
For Patients within West Lancashire contact Ormskirk 0300 2470011 (option 5).
For patients within Blackpool and Fylde and Wyre area, please contact 01253 953486 Monday – Friday 09:00am – 11:00am.
For patients within East Lancashire and Blackburn with Darwen, please contact 01254 735015.
Blood Glucose Testing:
Blood glucose testing should be done at least two–four hourly so that you can prevent hypoglycaemia by taking extra carbohydrate in the form of clear fluids if required.
If your blood glucose goes below 4mmol, take 220mls glass of Lucozade or normal Coke or lemonade or six glucose tablets immediately.
Hypoglycaemia:
Hypoglycaemia should be treated with six glucose tablets or 220mls glass of Lucozade®, lemonade or Coke. This should be repeated if the symptoms are not resolving, or the blood glucose is not rising after 15 minutes.
