Guidance for Managing Diabetes for Gastroscopy / EUS / ERCP

This guidance is provided to assist with your preparation for your endoscopic procedure. If you feel unclear about how to proceed after reading this information, please contact the Endoscopy Booking Assessment Nurse or your Diabetes Specialist Nurse, Practice Nurse or General Practitioner for personalised diabetes advice.

We do aim to give a morning appointment to patients with insulin treated diabetes and an early afternoon appointment to patients with non-insulin treated diabetes. If you are on insulin therapy and your appointment time is after 10am, please contact the Endoscopy Booking Team via the phone number on the back of this leaflet.

You must have nothing to eat for 6 hours before your procedure. You may continue to drink water for up to 2 hours before your procedure. This may upset your diabetes and you may be at risk of having a ‘hypo’ (too low blood sugar).

We don’t routinely admit patients with diabetes to hospital before their procedure, unless their diabetes is particularly unstable.

You will need to monitor your diabetes control carefully, particularly on the day before and the day of the procedure. We would recommend that you check your pre-meal blood sugar levels regularly and that you seek medical advice if your diabetes control is unsatisfactory.

Please be aware we are a Teaching Hospital and may have trainees in any areas of your pathway. They will always be supervised and they will always be working at an appropriate level for their training stage. If you would rather not have a trainee involved in your care please let the staff know your wishes. This will not affect your care.

• Oral diabetes medication (glucose lowering tablets): Acarbose, Metformin, Nateglinide, Pioglitazone.

DPP4 inhibitors: Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin.

SGLT2 inhibitors: Canagliflozin (Invokana®), Dapagliflozin (Forxiga®), Empagliflozin (Jardiance®), Ertugliflozin GLP1 agonist: Semaglutide (Rybelsus)

Sulfonylureas: Glibenclamide, Gliclazide, Glimepiride, Glipizide, Tolbutamide.

• Long acting/intermediate acting insulin: Abasaglar, Humulin I, Hypurin porcine Isophane, Insulatard, Insuman Basal, Lantus, Levemir, Semglee, Toujeo, Tresiba.

• Quick acting or meal time insulin: Actrapid, Apidra, Fiasp, Humalog, Humulin S, Hypurin porcine neutral, Insuman Rapid, Lyumjev, Novorapid, Trurapi.

• Other injectable treatment (GLP-1): Daily injections of GLP-1 agonist therapy (e.g. Exenatide (Byetta), Liraglutide (Victoza) or Lixisenatide (Lyxumia) Semaglutide (Ozempic)) Xultophy (insulin degludec + liraglutide).

Weekly injections of GLP-1 agonist therapy (e.g. Dulaglutide (Trulicity), Exenatide MR (Bydureon) or Semaglutide (Ozempic)).

• Premixed/Biphasic insulin: Humalog mix 25, Humalog mix 50, Humulin M3, Hypurin porcine 30/70 mix, Insuman comb 25, Novomix 30.

If your diabetes medicine is not included in the list, please contact the Endoscopy Booking Assessment Nurse or your Diabetes Specialist Nurse, Practice Nurse or General Practitioner. 

You must have nothing to eat for 6 hours before your procedure. You may continue to drink water for up to 2 hours before your procedure. This may upset your diabetes and you may be at risk of having a ‘hypo’ (too low blood sugar). You are advised to carry glucose tablets in case this happens.

If you normally self-test blood glucose, it is advisable to check your blood glucose level every 4-6 hours, if you feel unwell or if you feel ‘hypo’.

If your blood sugar falls to around 5mmol/L or less or if you experience hypoglycaemic symptoms (such as sweating, shaking, palpitations, nausea, headache, speech difficulty, confusion etc.), take 15-20 grams (gr) of carbohydrate in a sugary drink such as 200mls of Glucose (Lucozade) drinks or 150mls of non-diet fizzy drinks. Then recheck the blood glucose 15 minutes after.

Patients on oral diabetes medication 

Oral diabetes medication, Acarbose, Nateglinide. Day before procedure, take as normal. Day of Procedure Omit if your dose is due when not eating. Day after Procedure, take as normal.

Oral diabetes medication, Metformin. Day before procedure, Take as normal. Day of procedure, Take as normal. Day after Procedure, Take as normal.

Oral diabetes medication, Pioglitazone. Day before procedure, Take as normal. Day of procedure, Take as normal. Day after procedure, Take as normal.

Oral diabetes medication, DPP4 inhibitors: Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin. Day before procedure, Take as normal. Day of procedure Take as normal. Day after Procedure, take as normal.

Oral diabetes medication, Long-acting Sulfonylureas: Glibenclamide & Glimepiride. Day before procedure, Take as normal. Day of procedure, Take normal dose after procedure if eating and drinking normally. Day after Procedure, Take as normal.

Oral diabetes medication, Sulfonylureas: Gliclazide, Gliclazide MR, Glipizide & Tolbutamide. Day before Procedure, Take as normal. Day of procedure, omit any morning dose.Take any evening doses if eating and drinking normally. Day after Procedure, Take as Normal.

Oral diabetes medication, GLP1 agonist: Semaglutide (Rybelsus). Day before procedure, Take as Normal. Day of Procedure, Do not take. Day after Procedure, Take as Normal.

Patient on Insulin.

Patients on insulin should follow the advice in the tables on pages 8 & 9. Note that the advice differs for patients on long acting insulin depending on whether they also take quick-acting insulin.

If you are on a continuous subcutaneous insulin infusion (insulin pump), continue usual basal rate of insulin infusion but do not give any bolus doses whilst fasting for the test and until the procedure has been done and you are eating normally. Check blood glucose frequently and use correction doses only for significantly elevated blood glucose readings during preparation for Gastroscopy/ EUS/ ERCP until after the procedure. If you have any concerns about hypoglycaemia (low blood sugars) you can use a temporary basal rate that is 80% of your usual rate. If necessary, you can contact the Endoscopy Booking Assessment Nurse or your Diabetes Specialist Nurse, Practice Nurse or General Practitioner for personal advice.

Injections, Long-acting insulin only once or twice per day (without quick-acting insulin). Day before Procedure, Take as Normal. Day of Procedure, Take 50% of your usual dose on the morning of your procedure (if any doses are due). Take your usual dose as normal for any evening dose due. Day after Procedure Take as normal.

Injections, Long-acting insulin once a day in the evening. Day before Procedure Take 80% of your usual dose. Day of Procedure Take as normal. Day after Procedure Take as normal.

Injections, Long-acting insulin once a day in the morning. Day before Procedure, Take as Normal. Day of Procedure, Take 80% of your usual dose. Day after Procedure, Take as Normal.

Injections, Long-acting insulin twice a day. Day before Procedure, Take as normal in the morning. Take 80% of your usual dose in the evening. Day of Procedure, Take 80% of your usual dose in the morning. take as normal in the evening. Day after Procedure, Take as Normal. 

Injections, Quick-acting insulin. Day before Procedure, Take as Normal. Day of Procedure, Omit morning dose if no breakfast is eaten. Omit lunchtime dose if still fasting. Resume normal dose with evening meal. Day after Procedure, Take as Normal.

Injections, Pre-mixed insulin twice or three times a day. Day before Procedure, Take as Normal. Day of Procedure, Take 50% of your usual dose, for any doses due before the procedure. Resume taking your usual dose after the procedure. Day after Procedure, Take as Normal. 

If you can’t eat a full meal in the evening after the procedure, you may consider reducing the dose of insulin taken with the evening meal.

Patients on GLP-1 agonist injections

Injections, If you are on daily injections of GLP-1 agonist therapy Short-acting: Exenatide (Byetta), Liraglutide (Victoza) or Lixisenatide (Lyxumia). Day before Procedure, Take as Normal. Day of Procedure, Take as Normal. Day after Procedure, Take as Normal.

Injections, If you take the insulin degludec with liraglutide combination product (once daily): Xultophy. Day before Procedure, Take as Normal. Day of Procedure, Take 80% of your usual number of dose steps. Day after Procedure Take as Normal.

Injections, Long-acting (once weekly): Dulaglutide (Trulicity) Exenatide MR (Bydureon), Semaglutide (ozempic). Take Usual dose at usual time.

Example

If taking 10 units, 50% 5 units, 80% 8 units

If taking 20 units, 50% 10 units, 80% 16 units

If taking 30 units, 50% 15 units, 80% 24 units

If taking 40 units, 50% 25 units, 80% 32 units

If taking 50 units, 50% 25 units, 80% 40 units.

• Write down your medication plan for the day before the procedure, the day of the procedure and the day after your endoscopic procedure. Sedation can affect your thinking so it may be helpful to write down your plan in the table below.

• If you have any concerns about managing your diabetes while preparing for this procedure please contact the the Endoscopy Booking Assessment Nurse, your Diabetes Specialist Nurse, Practice Nurse or General Practitioner for personalised advice.

Please bring a list of your medication with you on the day.

Please leave valuables and jewellery at home where possible as we unfortunately are unable to look after these.

Remember to bring the following with you to hospital:

• Blood glucose testing equipment (if you usually monitor your blood glucose)

• The tablets you usually take for your diabetes

• Your morning insulin syringes and some food so your insulin can be given with some food after the procedure. If the District Nurse administers your insulin in the morning, please also bring your folder.

Due to the risk of a hypoglycaemic 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 5.0 mmol/L.

Please remind staff that you have diabetes on arrival to the Gastroenterology & Endoscopy Unit.

Access from the main hospital multistorey car park

We are located in Area 6 - Gastroenterology & Endoscopy Unit, highlighted in orange on the main hospital map. Follow the signs for the Main Hospital up the escalator/lift towards Area 6, second corridor on the left. Follow the signs down the link corridor, exit to the right via the side door (external) which is signposted for Patient Entrance to Reception.

Access for drop off/collection only & disability parking

Enter via East Park Drive and follow the road up the hill, take the second left signposted for Gastroenterology & Endoscopy Unit Drop off only, follow the road round to the right.