South of Tyne Bowel Cancer Screening Programme How to prepare for your colonoscopy using bowel preparation Type 1 and type 2 diabetes - insulin treated diabetes management (Evening appointment) December 2012 1
Introduction You agreed to take part in the National Bowel Cancer Screening Programme. As part of the screening process you provided a stool sample for analysis in which traces of blood were found. A colonoscopy examination is now recommended to investigate your large bowel further. Colonoscopy - the inspection of the large bowel (colon) using a flexible camera (colonoscope). This leaflet tells you how to prepare for your colonoscopy using two types of laxative. These come as two sachets and six tablets. The laxatives will work together to cleanse your bowel. You must also follow a special diet set out in the leaflet. The diet includes taking special drinks; these are a complete diet in liquid form and need to be taken at the appointed times. What is the bowel preparation? The two sachets contain a sugar free powder, this is a strong laxative. The tablets are Senna tablets, you will need to take 6 of these, they are also a laxative. Why do I need bowel preparation? The colonoscopy looks at the inside of the large bowel. To have a successful examination, the bowel must be empty and clean. If the bowel is not empty and clean, it is not possible to see it all adequately and this could mean the test needing to be repeated. Before taking bowel preparation Please read the information leaflets enclosed in the preparations. Contact the Screening Practitioner (telephone number on back of leaflet) if you answer yes to any of the health questions and they were not discussed at your pre-assessment appointment. Are you allergic to any of the ingredients listed on the packets? Are you taking Warfarin or Clopidogrel tablets? Do you suffer from any kidney disease? Do you have congestive cardiac failure? When do I start to prepare for my colonoscopy? 7 days before your appointment Stop taking iron tablets Iron makes inside your bowel black, this makes it difficult to see everything. 2
4 days before your appointment Stop taking any medication that may cause you to be constipated, for example; Lomotil, Loperamide or Codine Phosphate. Continue to take all other normal medications. 2 days before your appointment Stop taking Fybogel or any other fibre products The fibre content of these products will work against the special diet you are about to start. Start your special diet at breakfast Eat from the foods on the diet list unless you are allergic to, or have been advised to avoid certain foods. Do not eat any foods or have any drinks that are not on this diet list. No milk in any form Diet list Meat: Fish: Eggs: lean meat for example; chicken, turkey, beef, ham and rabbit white fish only (do not fry) boiled, poached or scrambled no milk to be used Vegetables: no vegetables other than potatoes, boiled or mashed only no milk to be used Cereals: Bread: Fats: Other: Drinks: white rice and pasta, boiled only no wholemeal varieties white bread and white bread rolls only a daily allowance of 25g (1oz) butter or margarine sugar free plain jelly, artificial sweeteners and salt black tea or coffee, sugar free fruit squash (not real fruit juice), sugar free fizzy drinks, marmite, oxo, Bovril, soda water, water, flavoured water, herbal/fruit teas Supplement drinks: Supplied at your pre assessment appointment Drink fluids regularly drink a glass of fluid, from the diet list, every hour throughout the day until bedtime. No alcohol. 3
1 day before your appointment Insulin treated: You are advised not to go to work on this day. You should expect frequent bowel motions within 3 hours of starting your bowel preparation. Some abdominal cramping is normal, stay within easy reach of the toilet. Increase the frequency of blood glucose monitoring once bowel preparation is started. At midday have a light lunch from the diet list and supplement drink, this should be sipped slowly. Take insulin if normally taken. Drink fluids regularly drink a glass of fluid, from the diet list, every hour throughout the day until bedtime. No alcohol. At 3pm take 6 Senna tablets with plenty of water. At 5pm have a light evening meal from the diet list and a supplement drink. (This will be your last meal, no more solid foods until after your examination.) At 6pm dissolve the content of one sachet of the bowel preparation in a heat proof mug with 200ml (8 fluid oz) of cold water. Stir for 2 minutes and leave to stand for 30 minutes (the mixture may become hot and needs to cool). Once cooled drink the solution. Bed time, have a supplement drink, this should be sipped slowly. If you feel unwell If at any time you feel; dizzy, sweaty or irritable (hypo) take: or or 2-3 teaspoons of sugar dissolved in warm water 3-4 glucose tablets 50ml glass of lucozade This should be followed by a starchy snack within 20 minutes; it is advisable to monitor your blood glucose levels regularly. If you do not feel better almost immediately please contact your usual diabetic carer for further advice. If you recover and feel your normal self, continue with the bowel preparation instructions. 4
What do I do on the day of the colonoscopy? 8am have a supplement drink, this should be sipped slowly. At 10am dissolve the second sachet of bowel preparation as described above and drink the solution once cooled. 12 noon have a supplement drink. You are allowed to drink fluids, from the diet list, until 2 hours before your appointment. You may receive sedation during your colonoscopy examination, it is important that you stop drinking 2 hours before your appointment. Attend the Endoscopy Unit at your appointment time. Please inform the nursing staff on arrival if you are not passing clear liquid as you may require an enema prior to your examination. Please bring Insulin and a snack into hospital for after the procedure. What can I expect of the bowel preparation? The bowel preparation can begin to work within 3 hours of taking it. You will open your bowels frequently and eventually your motions should change from soft to loose to watery. Stay close to a toilet as you will use it regularly. You may experience some abdominal cramp this is normal in some people. The skin around your bottom can become red and sore due to frequent diarrhoea. A barrier cream such as Vaseline or nappy rash preparations can protect the skin. The soreness is temporary and will disappear in a few days. Are there any side effects from bowel preparation? You may experience head aches, nausea and sometimes vomiting. Abdominal bloating can occur and, less frequently, abdominal cramps. Most side effects are due to dehydration and can be avoided by drinking adequate amounts of fluid. 5
If you require any further advice or information regarding your bowel preparation contact: The Bowel Screening Centre 0191 445 6179 Monday to Friday (8.30am - 5.00pm) Accident and Emergency Department (QEH) 0191 445 2171 Queen Elizabeth Hospital 0191 482 0000 South Tyneside District Hospital 0191 404 1000 City Hospitals Sunderland 0191 565 6256 Information Leaflet: NoIL91 Version: 2 Title: First Published: November 2007 Last Reviewed: December 2012 Review Date: December 2014 Author: Mary Ritchie How to prepare for your colonoscopy for Type1 and 2 diabetes using bowel preparation (evening appointment) insulin treated diabetes management This leaflet can be made available in other languages and formats upon request 6