Guidance for Managing Diabetes for Gastroscopy & Sigmoidoscopy or Gastroscopy & Colonoscopy (known as Dual Procedures)

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 not prior to 10am, please contact the Endoscopy
Booking Team via the phone number on the back of this leaflet.

The necessary change in your diet may upset your diabetes. You
may, on days leading up to your procedure be at risk of having a
‘hypo’ (too low blood sugar). When on the diet of clear fluids, you
should take sweet drinks every 2-3 hours to avoid hypoglycaemia.
You are also advised to carry glucose tablets in case this happens.

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. The low residue diet
can be combined with your usual medication. 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®).

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)).

• 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 your Diabetes Specialist Nurse or your General
Practitioner.

The meals that you miss prior to your Gastroscopy with Sigmoidoscopy
or Colonoscopy procedure will be determined by the bowel preparation
that you are given (Moviprep, Picolax, Kleanprep or Plenvu) and
whether you are given a Morning or Afternoon appointment as follows:

Morning appointment – meals that you miss.

Moviprep, Day before Procedure, Lunch and Evening Meal. Day of Procedure, Breakfast.

Picolax, Day before Procedure, Breakfast, Lunch and Evening Meal. Day of Procedure, Breakfast.

Kleanprep, Day before Procedure, Evening Meal. Day of Procedure, Breakfast.

Plenvu, Day before Procedure, Evening Meal. Day of Procedure, Breakfast.

Afternoon appointment - meals that you miss.

Moviprep, Day before Procedure, Evening Meal. Day of Procedure, Breakfast and Lunch.

Picolax, Day before Procedure, Evening Meal. Day of Procedure, Breakfast and Lunch.

Kleanprep, Day before Procedure, Evening Meal. Day of Procedure, Breakfast and Lunch.

Plenvu, Day before Procedure, Evening Meal. Day of Procedure, Breakfast and Lunch.

We will provide you with a separate patient information leaflet with more
information about the bowel preparation you need to take prior to your
procedure.

The necessary change in your diet may upset your diabetes. You may,
on days leading up to your procedure be at risk of having a ‘hypo’ (too
low blood sugar). When on the diet of clear fluids, you should take
sweet drinks every 2-3 hours to avoid hypoglycaemia. You are also
advised to carry glucose tablets in case this happens.

When your bowel preparation instructions permit you to eat a light
lunch* on the day before your procedure, you may need quick acting
insulin for your lunch if it includes carbohydrates.

*Light lunch: please avoid all food containing roughage, including
wholemeal bread and vegetables.

As you are having a dual procedure, 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.

Please be aware: Monitor your blood sugar every 4-6 hours.

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 Glucose (Lucozade)
drinks – 200mls or 150-200ml of non-diet fizzy drinks. These drinks
can also be sipped slowly at mealtimes to replace your usual dietary
carbohydrate.

You may need to be flexible with the amount of sugary drink ingested;
for instance, take smaller quantities than suggested above if the blood
sugars are too high at mealtimes (say 12mmol/L or more), despite your usual doses of tablets.

Patients on oral diabetes medication

Oral diabetes medication, Acarbose, Nateglinide. Day before Procedure, Take as Normal. Day after Procedure, Take as Normal.

Oral diabetes medication, Metformin. Day before Procedure, Take as Normal. Day of Procedure, take as normal if taken once or twice a day. If taken three times a day omit lunchtime dose only. 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, SGLT inhibitors: Canagliflozin, Dapagliflozin, Empagliflozin. Day before Procedure, Do not take. Day of Procedure, Do not take. Day after Procedure, Take as Normal if eating and drinking normally.

Oral diabetes medication, Long acting Sulfonylureas: Glibenclamide & Glimepiride. Day before Procedure, Do not take. 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, Do not take. Day of Procedure, Omit any morning doses. 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.

Patients on Insulin

Patients on insulin should follow the advice in the tables on pages 7,
9 & 10. Note that the advice differs for patients on long-acting insulin
depending on whether they also take short 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 not eating proper meals preparing for
the procedure 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 Sigmoidoscopy or Colonoscopy 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 Personalised advice.

Injections, Quick acting insulin. Day before Procedure Take as normal for any meals consumed. Omit the quick acting insulin for individual missed meal(s). Day of Procedure, Omit any doses due before the procedure. Take as normal for any meal(s) consumed after the procedure. 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 for 2 days before the procedure. Day of the Procedure, Take usual dose in the evening. Day after Procedure, Take as normal.

Injections, Long-acting insulin once a day in the morning. Day before Procedure, *Take 80% of your usual dose one day before the procedure. 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 80% of your usual dose one day before the procedure. Day of Procedure, *Take 80% of your usual dose on the morning of the procedure. Go back on your usual evening dose after the procedure. Day after Procedure, Take as normal.

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

Injections,  Pre-mixed/ biphasic insulin twice or three times a day. Day before procedure, *Take 50% of your usual dose one day before the procedure. 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.

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, Exenatide (Byetta): Omit morning dose, take evening dose as usual. Liraglutide and Lixisenatide: Take as normal. Day after Procedure, Take as normal.

If you take the insulin degludec with liraglutide combination product (once daily): Xultophy. Day before Procedure, *Take 50% of your usual number of dose-steps. Day of Procedure, *Take 50% of your usual number of dose-steps if taken in the morning. Take as normal if taken in the evening. Day after Procedure, Take as normal.

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% 20 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 day, 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 investigation please contact the Diabetes
Specialist Nurses (for patients within Blackpool area and
North Lancashire please contact 01253 953486 Monday-
Friday 08.30am-10.00am) or alternatively you can contact
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 to the
appointment, so your insulin can be given with some food after
the investigation. If the District Nurse administers your insulin in
the morning, please also bring your folder.

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 5.0 mmol/L.

Please remind staff that you have diabetes on arrival to the
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.