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COLONOSCOPY COLONOSCOPY INSTRUCTIONS FOR PATIENTS WITH DIABETES TYPE 1 AND TYPE 2

COLONOSCOPY COLONOSCOPY INSTRUCTIONS FOR PATIENTS WITH DIABETES TYPE 1 AND TYPE 2 General Instructions See your General Practitioner GP at least 2 weeks before your colonoscopy to get instructions on how to access and use a blood glucose testing kit testing strips and testing lancet unless you are already testing and have unexpired blood glucose test strips available From the day before the colonoscopy check your blood glucose level every 3 hours when awake When you are fasting having nothing to eat or drink check your blood glucose every 2 hours If you do not use a glucometer to check your blood glucose levels at home please contact your GP who will advise if you need a glucometer If you feel shaky faint hot or sweaty you should also check your blood glucose These feelings can be a sign of low blood glucose You should check your blood glucose level and if it is less than 4mmol L you should treat as a hypoglycaemia Hypoglycaemia Treatment If your blood glucose level is 4 0 mmol L or less 1 Drink a glass 150mls of non diet ordinary lemonade or apple juice 2 Re check your blood glucose level 15 minutes later and if it is still less than 4 0 mmol L drink a further glass 150mls of non diet ordinary lemonade or apple juice 3 4 Re check your blood glucose level 15 minutes later and if it is still less than 4 0 mmol L drink a glass 150mls of non diet ordinary lemonade or apple juice This can be repeated every 15 minutes if the blood glucose remains less than 4 0 mmol L 5 Continue to check your blood glucose every 15 minutes until it has been above 4 0 mmol L for 45 minutes 6 Then resume checking every hour until blood glucose level is above 6mmol L 7 When your blood glucose level is between 6 10 mmol L you can continue to check your blood glucose level every 2 hours 8 If you have a hypoglycaemic episode before you come into hospital for your procedure please tell the nurse on duty when you are admitted

The following instructions use the words CLEAR NON DIABETIC FLUIDS Examples are clear fruit juices without pulp such as apple juice ordinary non diet soft drinks such as lemonade and ordinary non diet cordial syrup mixed with water These are drinks that someone with diabetes would usually avoid but for these special circumstances they can be used Diabetes medications Check which types of diabetes medications you are on and then follow the instructions in the next sections Any tablets for diabetes Diabetes Tablets Lantus Levemir Tresiba Toujeo Long acting insulin Novorapid Humalog Apidra Fiasp Short acting insulin Novomix 30 Humalog Mix 25 Mixed insulin Humalog Mix 50 Byetta Bydureon Victoza Trulicity GLP 1 injections Ozempic Continuous Subcutaneous Insulin Infusion Novorapid Humalog Pump Insulin Pump or Fiasp Insulin 72 hours prior to starting bowel preparation you should STOP taking your SGLT 2 medications and you should not resume these medications until you are eating a full normal diet after your procedure with no nausea SGLT 2 medications should not be resumed on the day of your colonoscopy SGLT 2 medications are Empagliflozin Jardiance Canagliflozin Invokana Dapagliflozin Forxiga Ertugliflozin Steglatro If you are not sure of your medications or if you are on a tablet that contains one of these medications please contact your GP at least week before the procedure for advice

The day before the Colonoscopy Time Instructions for Diabetes Medications Breakfast Time 8 9am Omit all diabetes tablets Morning Colonoscopy Appointment If you have a morning colonoscopy appointment you can have a light breakfast of white diet only before 9am see bowel prep instructions for details Omit dose of Byetta Bydureon Victoza Trulicity or Ozempic Afternoon Colonoscopy Appointment If you have an afternoon colonoscopy appointment you can have a light breakfast of white diet only see bowel prep instructions for details Take usual dose of short acting insulin if given at this time with breakfast Lunch Time 12noon 1pm Omit all diabetes tablets Morning Colonoscopy Appointment If you have a morning colonoscopy appointment you can have CLEAR FLUIDS only No food allowed Omit dose of Byetta Bydureon Victoza Trulicity or Ozempic Afternoon Colonoscopy Appointment If you have an afternoon colonoscopy appointment you can have a light lunch of white diet only before 1pm see bowel prep instructions for details After lunch you should have CLEAR FLUIDS only This can be a glass of apple juice ordinary non diet soft drink or cordial diluted with water according to instructions on the bottle every 2 3 hours In addition you should drink plenty of water at least 2 litres of water Both morning and afternoon Colonoscopy Appointment In the evening on the day BEFORE the colonoscopy you should have CLEAR FLUIDS only In addition make sure that you have drank plenty of water during the day we recommend at least 2 litres of water over the day before your colonoscopy Take usual dose of long acting insulin if given at this time Insulin Pump Do not change basal rates Bolus as usual If your colonoscopy appointment is in the morning you will omit lunch and will not require your short acting lunch time novorapid dose If your colonoscopy appointment is in the afternoon you will be eating a light lunch and will require your usual lunch time short acting insulin dose Insulin pump Do not change basal rates If your blood glucose becomes HIGHER than 15mmol L you should enter your blood glucose level into the bolus calculator and give the suggested correction dose Omit all diabetes tablets Omit dose of Byetta Bydureon Victoza Trulicity or Ozempic If you usually take long acting insulin Lantus Levemir Tresiba Toujeo in the evening or before bed you should have your full USUAL dose If you usually take short acting insulin eg Humalog NovoRapid Apidra Fiasp this dose should be omitted If you usually take mixed insulin eg NovoMix Mixtard Humalog Mix with your evening meal you should take HALF your usual dose Insulin pump Do not change basal rates If your blood glucose becomes HIGHER than 15mmol L then you should enter your blood glucose level into the bolus calculator and give the suggested correction dose

The day of the Colonoscopy If you are having the Colonoscopy in the morning Time Instructions for Diabetes Medications Morning Colonoscopy Omit all diabetes tablets Fast nothing at all to drink from 2 hours prior to procedure Omit dose of Byetta Bydureon Victoza Trulicity or Ozempic Check your blood glucose level BGL every 2 hours Target BGL is 6 10mmol L If your BGL is outside the target range then commence hourly BGL readings If you usually take long acting insulin Lantus Levemir Tresiba Toujeo in the morning you should have HALF of your usual dose If the glucose level is less than 4 0 mmol L see page 2 for instructions on HYPOGLYCAEMIA TREATMENT If you have any blood glucose level below 4mmol L please inform the nurse in the endoscopy unit when you arrive After the colonoscopy Do NOT take any short acting insulin NovoRapid Humalog Apidra Fiasp If you usually take mixed insulin NovoMix Humalog Mix in the morning you should take HALF your usual dose Insulin pump When you start fasting you should set a temporary basal rate of 70 Keep this setting until after you have had your colonoscopy If your blood glucose level becomes HIGHER than 15mmol L you should enter your blood glucose level into the bolus calculator and give the suggested correction dose All diabetes medications including insulin should be recommenced with no dose reduction at the usual times they are given when you are eating and drinking again EXCEPT SGLT 2 inhibitor tablets See below If the morning dose of Bydureon Trulicity or Ozempic was omitted then administer the usual dose after your evening meal Insulin pump End the temporary basal rate give a correction bolus if required Bolus with food in the usual way SGLT 2 inhibitors should be held for 2 days after the procedure and when you are back eating and drinking a full diet with no nausea or vomiting You MUST arrange for an adult to drive you to the hospital and to collect you after your procedure to drive you home

The day of the Colonoscopy If you are having the Colonoscopy in the afternoon Time Instructions for Diabetes Medications Afternoon Colonoscopy Appointment Omit all diabetes tablets Fast nothing at all to drink from 2 hours prior to procedure Omit dose of Byetta Bydureon Victoza Trulicity or Ozempic Check your blood glucose level BGL every 2 hours Target BGL is 6 10mmol L If your BGL is outside the target range then commence hourly BGL readings If you usually take long acting insulin Lantus Levemir Tresiba Toujeo in the morning you should take HALF of your usual dose If the glucose level is less than 4 0 mmol L see page 2 for instructions on HYPOGLYCAEMIA TREATMENT If you have any blood glucose level below 4mmol L please inform the nurse in the endoscopy unit when you arrive After the colonoscopy If you usually take short acting insulin eg Humalog NovoRapid Apidra Fiasp this dose should be omitted If you usually take mixed insulin eg NovoMix Mixtard Humalog Mix with their morning meal you should take HALF your usual morning dose Insulin pump When you start fasting you should set a temporary basal rate of 70 Keep this setting until after you have had your colonoscopy If your blood glucose level becomes HIGHER than 15mmol L you should enter your blood glucose level into the bolus calculator and give the suggested correction dose All diabetes medications including insulin should be recommenced with no dose reduction at the usual times they are given when you are eating and drinking again EXCEPT SGLT 2 inhibitor tablets See below If the morning dose of Bydureon Trulicity or Ozempic was omitted then administer the usual dose after your evening meal Insulin pump End the temporary basal rate give a correction bolus if required Bolus with food in the usual way SGLT 2 inhibitors should be held for 2 days after the procedure and when you are back eating and drinking a full diet with no nausea or vomiting Patients with Type 1 diabetes who are preparing for a colonoscopy and have a Blood glucose level more than 12mmol L should check their blood for ketones and follow their usual sick day rules If your Blood glucose level or ketone level continues to rise despite corrective insulin please contact your usual diabetes team or out of hours the Emergency Department You MUST arrange for an adult to drive you to the hospital and to collect you after your procedure to drive you home

References Hamblin P et al 2021 Capillary Ketone Concentrations at the Time of Colonoscopy A Cross Sectional Study with Implications for SGLT2 Inhibitor Treated Type 2 Diabetes Diabetes Care 2021 44 e124 e126 https doi org 10 2337 dc21 0256 Meyer E J et al 2020 Periprocedural euglycemic diabetic ketoacidosis associated with sodium glucose cotransporter 2 inhibitor therapy during colonoscopy Diabetes Care 2020 43 e181 e184 2 Australian Diabetes Society Alert update September 2020 Periprocedural diabetic ketoacidosis DKA with SGLT2 inhibitor use Available at https diabetessociety com au downloads 20201015 20ADS_DKA_SGLT2i_Alert_update_Sept_2020 p df accessed 30 03 2022 Western Health Care Australia 2019 Colposcopy Diabetes Guidelines Available online at https www westernhealth org au Services Endosco pic Documents Colonoscopy 20diabetes 20guidel ines 202019 pdf Accessed 30 3 22 Location and Parking Information Beacon Hospital is located in Sandyford Dublin 18 and can be accessed by Luas Dublin Bus and car LUAS The Luas green line goes directly from the City Centre to Sandyford Beacon Hospital Dublin is located in Sandyford 10 minutes walk from the Kilmacud Luas station On exiting the Luas at the Kilmacud station take the lift stairs and follow the pathway to the entrance of the station Turn left here and you will see Beacon Hospital located at the top of the road at the crossroads this is right beside the Beacon Hotel DUBLIN BUS Beacon Hospital is serviced by the following bus routes No 11 bus from Wadelai Park via O Connell Street Alight at stop no 4847 Blackthorn Drive Luas Car Park No 75 bus from Tallaght Dun Laoghaire Alight at stop no 449 Blackthorn Road Corrig Road CAR PARKING An underground public car park is available by turning right on entering the Beacon Court car park You may pay your ticket fee on exiting the hospital lobby

Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 6600 www beaconhospital ie Version 19 8 2022