York Teaching Hospital NHS Foundation Trust Information for Patients with Diabetes having Lower Endoscopic Investigations requiring full bowel preparation Morning Appointment Information for patients, relatives and carers For more information, please contact: Diabetes and Endocrine Unit The York Hospital Wigginton road, York, YO31 8HE Tel: 01904 726510 Scarborough Hospital Woodlands Drive, Scarborough, YO12 6QL Tel: 01723 342274
Our Values: Caring about what we do Respecting and valuing each other 2 Caring with Pride: Our ultimate objective is to be trusted to deliver
Listening in order to improve Always doing what we can to be helpful Contents Page General advice 4 What to do with your medication. 5 Monitoring your blood glucose levels 6 What is a hypo? 6 What to do after your procedure 7 Insulin recommendations for Morning Appointment 8 Day before examination 8 Day of test 9 After the test 10 safe, effective and sustainable healthcare within our communities 3
Our Values: Caring about what we do Respecting and valuing each other General advice For a successful examination to be carried out, it is very important that the bowel is completely clean and you adhere to the following instructions. If the instructions are not followed correctly the examination may have to be repeated. Some investigations required you to fast for extended periods of time to ensure the bowel is completely clean. For people with diabetes, any procedure that causes you to miss a meal or change your usual meal plan will require special planning to safely manage your blood glucose. Some diabetes treatments can, if taken without food cause your blood glucose level to drop too low i.e. you can become hypoglycaemic. (Blood glucose below 4mmol/L) For this reason we recommend some alterations to some of your usual diabetes medication. 4 Caring with Pride: Our ultimate objective is to be trusted to deliver
Listening in order to improve Always doing what we can to be helpful For people treated with, try and avoid your blood glucose dropping too low when you are fasting. You may need to take regular amounts of sugary drinks instead of solid food at your usual mealtimes. Include one of the following sugary drinks. 200mls Lucozade 300mls Coca Cola (not diet ) 200mls clear apple juice What to do with your medication. For people who take injections it is recommended you reduce your doses the day of your bowel preparation and the day of the test. The chart on pages 8-10 will help you manage your diabetes treatment if taking when undergoing your bowel preparation or fasting period. For people on tablets the recommendation is you do not take any of your diabetes tablets the day before the test and on the morning of your test. You can restart your usual medication after the test is complete. If you are taking GLP-1 including Byetta (exenatide), Victoza (liraglutide) or Lyxumia (lixisenatide) by injection, these medications should not be taken on the day of your procedure and restarted once you start eating and drinking normally. safe, effective and sustainable healthcare within our communities 5
Our Values: Caring about what we do Respecting and valuing each other Monitoring your blood glucose levels If you monitor your blood glucose levels it is a good idea to check before each meal on the preparation day (day before the test) and before you arrive for your test and if at any time you have symptoms of hypoglycaemia (low blood glucose) or very high blood glucose. If you do not normally monitor your blood glucose levels at home, you do not need to do so for this period. Bring all your medication including, your blood glucose meter, test strips and hypo treatment with you on the day of the procedure. What is a hypo? A hypo is where your blood glucose level falls below the normal range usually less than 4mmol/L. This is usually associated with symptoms including feeling sweaty, shaky, feeling dizzy and heart racing. You need to treat your hypo immediately by taking rapid acting carbohydrate for example: 100mls Lucozade 150 mls - (mini can) coca cola or half a standard can 5-7 Dextrose tablets chewed 6 Caring with Pride: Our ultimate objective is to be trusted to deliver
Listening in order to improve Always doing what we can to be helpful Recheck your blood glucose level 10-15 minutes later, if still below 4mmol/L repeat with more rapid acting carbohydrate as above. Once your blood glucose level has risen above 4mmol/L recheck hourly to ensure your blood glucose does not drop too low again. What to do after your procedure The nursing staff will inform you when it is safe to eat and drink after your procedure. Take your tablets / as advised from the flowchart when you are able to have your next meal. When you get home your blood glucose levels may vary for a short time, but this should quickly return to your usual level. These are general guidelines, if you have any concerns please call the diabetes team for further advice. safe, effective and sustainable healthcare within our communities 7
Our Values: Caring about what we do Respecting and valuing each other Insulin recommendations for Morning Appointment Day before examination Follow dietary and bowel preparation as instructed Take additional clear fluids (e.g. black tea or coffee), some of it sugary (e.g. Lucozade, clear fruit juice: apple, grape) clear jelly puddings, or ice cream Test blood glucose at least four times a day Twice daily AM half dose PM half dose Four times daily Short Acting Insulin AM normal dose LUNCH omit dose TEA omit dose Long Acting Insulin Give two-thirds of usual dose Once daily Half dose 8 Caring with Pride: Our ultimate objective is to be trusted to deliver
Listening in order to improve Always doing what we can to be helpful Insulin recommendations for Morning Appointment Day of test Continue bowel prep as instructed Continue additional clear fluids (as above) until two hours before your appointment Test blood glucose every two hours Twice daily AM omit Four times daily Short Acting Insulin AM omit dose Long Acting Give two-thirds of usual dose Once daily AM omit safe, effective and sustainable healthcare within our communities 9
Our Values: Caring about what we do Respecting and valuing each other Insulin recommendations for Morning Appointment After the test Twice daily If able to eat before 11AM: Give normal morning dose after food If able to eat after 11 AM: Give half morning dose after food Give usual PM dose Four times daily When able to eat: Give normal short acting dose with food Give normal tea time & bedtime doses Once daily For patients on morning longacting : Give two-thirds of usual morning dose after food For patients on bedtime/evening long-acting : Give usual evening dose 10 Caring with Pride: Our ultimate objective is to be trusted to deliver
Listening in order to improve Always doing what we can to be helpful Tell us what you think We hope that you found this leaflet helpful. If you would like to tell us what you think, please contact Tara Kadis, Diabetes & Endocrine Unit, The York Hospital, telephone 01904 726510 or email tara.kadis@york.nhs.uk. Teaching, Training and Research Our Trust is committed to teaching, training and research to support the development of staff and improve health and healthcare in our community. Staff or students in training may attend consultations for this purpose. You can opt-out if you do not want trainees to attend. Staff may also ask you to be involved in our research. Patient Advice and Liaison Service (PALS) Patients, relatives and carers sometimes need to turn to someone for help, advice or support. Our PALS team is here for you. PALS can be contacted on 01904 726262, or via email at pals@york.nhs.uk. An answer phone is available out of hours. safe, effective and sustainable healthcare within our communities 11
Providing care together in York, Scarborough, Bridlington, Whitby, Malton, Selby and Easingwold Owner Tara Kadis Diabetes Team Date first issued October 2015 Review Date September 2017 Version 1 (issued October 2015) Approved by Diabetes and endocrine Team Document Reference PIL 960 v1 2015 York Teaching Hospital NHS Foundation Trust. All Rights reserved. www.yorkhospitals.nhs.uk