Diabetic Instructions

The aim of this information is to help you to prepare for your endoscopy procedure (colonoscopy, flexisigmoidoscopy or enteroscopy). Please read this thoroughly for advice on alterations needed to your diet and administration of bowel preparation medication to clean your bowel in the days leading up to your endoscopy test. You should follow these instructions, plus the instructions in the menus below that are specific to the diabetic medications you are taking. Please ensure you read both. 

These instructions for taking your bowel preparation replace those enclosed in the packets containing Moviprep. However, it is important you read the manufacturer’s leaflet inside the packet of preparation before you take the bowel preparation. The leaflet will tell you about the preparation itself, allergies, indications for taking or not taking the preparation, the possible side effects, the effect it can have on taking oral medications – in particular medications that may affect fluid balance, and when you should consult a doctor before taking the bowel preparation.
Any usual oral medication should be taken at least two hours before starting the Moviprep to minimise the risk of flushing the medication through the gut and not being fully absorbed.

The aim of the bowel preparation is to clean your bowel so that there are clear views of the lining of your bowel during your endoscopy procedure. If you are unable to take any of the bowel preparation for any reason or your bowel preparation does not work properly it is important you contact the endoscopy unit using the contact telephone number on your endoscopy appointment letter.
Poor bowel preparation may mean that your endoscopy procedure will be stopped or may not go ahead and you will need to repeat the preparations and endoscopy test on another day.

We understand we may be asking you to get up early on the day of your test to take your second sachets of bowel preparation.
Research shows that to achieve good views during your colonoscopy procedure and reduce the risk of missing lesions or polyps it is best to take the second part of your bowel preparation 5 hours before the time of your appointment for your endoscopy test. If you feel it is impossible to get up this early to take your bowel preparation please contact endoscopy.

Important information about some of the ingredients of Moviprep
Moviprep contains aspartame, which is a source of phenylalanine, which may be harmful for people with phenylketonuria (a genetic disorder affecting metabolism). It also contains ascorbate, which may be harmful for people with glucose-6-phosphate dehydrogenase deficiency. Do not take Moviprep if you have phenylketonuria or glucose-6-phosphate dehydrogenase deficiency, please contact endoscopy.
The remainder of this leaflet advises you on how to make up and how to take your Moviprep. This leaflet accompanies; What to do with your medication for your diabetes, diet and bowel preparation leaflet.

1st Dose: 7pm 

Make up your first dose of Moviprep by pouring the powder from one ‘A’ sachet and one ‘B’ sachet of Moviprep into a large jug and then add one litre of water to the jug and stir until the powder is completely dissolved and the solution is clear. You can add cordial (not blackcurrant) to flavour the Moviprep if you wish.

Drink one glassful (approximately 250mls or ½ pint) of the Moviprep every 15 minutes until you have drunk the whole jug (one litre). You should have completed drinking the whole jug of Moviprep in about one hour.

2nd Dose: 5 hours before your appointment time

Make up your second dose of Moviprep in the same way as the first and starting drinking it at least 5 hours before the appointment time of your endoscopy procedure, even if this means you getting up early to take the Moviprep.

For example if your appointment is:
9am you need to take your bowel prep at 4am
11am you need to take your bowel prep at 6am
3pm you need to take your bowel prep at 10am

Drink one glassful (approximately 250mls) of the Moviprep every 15 minutes over the next hour until you have drunk the whole jug (one litre).
You should continue to drink plenty of clear fluids up until two hours before the procedure, preferable water.
Examples of clear fluids that you may have are water, tea (without milk), coffee (without milk), Bovril, tonic water, no added sugar squash (no fizzy drinks) (no red or blackcurrant).
You should expect to be passing clear fluid bowel motions after taking the second jug of preparation.

The aim of this information is to help you to prepare for your endoscopy procedure (colonoscopy, flexisigmoidoscopy or enteroscopy). Please read this thoroughly for advice on alterations needed to your diet and administration of bowel preparation medication to clean your bowel in the days leading up to your endoscopy test. Please read this information, then additionally the information in the menus below regarding what to do with your specific diabetic medication.

These instructions for taking your bowel preparation replace those enclosed in the packets containing Plenvu. However, it is important you read the manufacturer’s leaflet inside the packet of preparation before you take the bowel preparation. The leaflet will tell you about the preparation itself, allergies, indications for taking or not taking the preparation, the possible side effects, the effect it can have on taking oral medications – in particular medications that may affect fluid balance, and when you should consult a doctor before taking the bowel preparation.
Any usual oral medication should be taken at least two hours before starting the Plenvu to minimise the risk of flushing the medication through the gut and not being fully absorbed.

The aim of the bowel preparation is to clean your bowel so that there are clear views of the lining of your bowel during your endoscopy procedure. If you are unable to take any of the bowel preparation for any reason or your bowel preparation does not work properly it is important you contact the endoscopy unit using the contact telephone number on your endoscopy appointment letter.
Poor bowel preparation may mean that your endoscopy procedure will be stopped or may not go ahead and you will need to repeat the preparations and endoscopy test on another day.

We understand we may be asking you to get up early on the day of your test to take your second sachets of bowel preparation.
Research shows that to achieve good views during your colonoscopy procedure and reduce the risk of missing lesions or polyps it is best to take the second part of your bowel preparation 5 hours before the time of your appointment for your endoscopy test. If you feel it is impossible to get up this early to take your bowel preparation please contact endoscopy.

Important information about some of the ingredients of Plenvu
Plenvu contains aspartame, which is a source of phenylalanine which may be harmful for people with phenylketonuria (a genetic disorder affecting metabolism). It also contains ascorbate which may be harmful for people with glucose-6-phosphate dehydrogenase deficiency. Do not take Plenvu if you have phenylketonuria or glucose-6-phosphate dehydrogenase deficiency, please contact endoscopy.
The remainder of this leaflet advises you on how to make up and how to take your Plenvu.

The day before the procedure

Plenvu is a two-dose preparation Dose 1 is a single mango-flavoured sachet. Dose 2 is two sachets (A and B) and fruit-punch flavour. All sachets must be taken with the right amount of water following the schedule below.

Dose 1: 7pm
7pm make up your first dose of Plenvu
Open the carton and remove Dose 1 (one sachet)
Pour the contents into a jug or container that can hold 500mls of fluid.
Add 500mls of water and stir until all the powder has dissolved, this may take up to 8 minutes.
Drink the 500mls of Plenvu, try to drink a glass full every 10 to 15 minutes over 30minutes till complete.

You should continue to drink plenty of clear fluids (at least 500mls or 1 pint) over the next couple of hours.
You should expect frequent bowel motions and eventually watery diarrhoea. Some stomach discomfort is normal. Please use a barrier cream if your bottom becomes sore and stay within easy reach of the toilet.

On the day of your procedure
Do not eat any solid food until after your procedure.
Make up your second dose of Plenvu drinking it at least 5 hours before the appointment time of your endoscopy procedure, even if this means you getting up early to take the Plenvu.

For example if your appointment is:
9am you need to take your bowel prep at 4am
11am you need to take your bowel prep at 6am
3pm you need to take your bowel prep at 10am

Dose 2: 5 hours before your appointment time:

Open the carton and remove Dose 2 (Two Sachets-Sachet A and Sachet B)
Pour the contents into a jug or container that can hold 500mls of fluid.
Add 500mls of water and stir until all the powder has dissolved, this may take up to 8 minutes.
Drink the 500mls of Plenvu, try to drink a glass full every 10 to 15 minutes over 30minutes till complete

You should continue to drink plenty of clear fluids up until two hours before the procedure, preferable water.
Examples of clear fluids that you may have are water, tea (without milk), coffee (without milk), Bovril, tonic water, no added sugar squash (no fizzy drinks) (no red or blackcurrant) .

You should expect to be passing clear fluid bowel motions after taking the second jug of preparation.

This information for patients with diabetes taking ‘insulin’ or ‘insulin and tablets’ or ‘tablets and other injectable treatments ’ for Lower Gastrointestinal Endoscopy Procedures MORNING & AFTERNOON appointment (no later than 2pm).

What to do with your medication for your diabetes, diet and bowel preparation medication
This leaflet advises you on how to prepare in the days leading up to your endoscopy procedure, either colonoscopy, sigmoidoscopy or enteroscopy.
It will help you understand:

What to do with your medication for your diabetes
When to take your bowel preparation
The required alterations to your diet to make sure your bowel preparation works and maintain your blood sugar levels

You should:
Have received an appointment in the morning or no later than 2pm in the afternoon-contact endoscopy if you have not
Ensure you DO NOT DRIVE to or from the hospital due to the possibility of low blood glucose readings
Check your blood glucose reading before leaving home if possible
Bring your diabetes tablets with you.
Bring your blood glucose monitor with you (if you have one)

Monitoring is important
Check your blood glucose every 2-4 hours if possible once you start fasting.
If you are feeling unwell and/or your blood glucose is over 15mmols check for ketones
(if you have been given ketostix or have a blood ketone meter and have been shown how to use them.
Contact the Endoscopy Centre or out of hours telephone number provided in your endoscopy information folder).
If your blood glucose is 4mmols or below. Follow treatment for hypoglycaemia guidance below.

Hypoglycaemia guidance
If any of your blood glucose readings are low (below 4 mmol/l), or you feel ‘hypo’ at any time:
Have a cup of FLAT Lucozade (170mls)
or
One 60ml bottle of LIFT drink (lemon & lime)
or
6-7 Dextrosol or Lucozade energy tablets
or
5 Glucotabs
It is advisable to avoid fizzy drinks as this may affect your endoscopy.
Re-check your blood glucose after 15 minutes and if your blood glucose remains less than 4 mmol/l then repeat this treatment.
Once you feel better you will need to follow it up with longer acting carbohydrate foods. Choose one of the following:
2 - 3 Rich Tea or Marie biscuits or 1 slice of white bread.
If your blood glucose remains low despite this treatment for over 30 minutes, please seek medical advice

Seven days before the procedure
If you are taking iron tablets please stop taking them, but continue all other medications including laxatives.
Four days before the procedure
If you are taking any constipating agents (e.g. loperamide, codeine phosphate etc.) stop taking them. Continue with all other medications until your appointment.
Three days before the procedure
Start following low fibre diet (please follow the link for this) for your meals and continue following low fibre diet advice until you start taking your bowel prep medication the evening before your procedure. For the best results in cleansing the bowel a low fibre diet is advised. Eating other foods may affect how well the bowel preparation works to ensure good views of your bowel during your procedure.

The day before your procedure

Breakfast and Lunch as usual using foods from low fibre diet allowed list
Take your usual diabetes tablet(s).
Take your usual dose(s) of insulin.
Take your usual injection of Exenatide (Byetta®) or Liraglutide (Victoza®) or Lixisenatide (Lyxumia ®).
Take your usual once weekly injection of Semaglutide (Ozempic®), Dulaglutide (Trulicity®), Exenatide (Bydureon®).

Tea-Time (Evening Meal) to be completed by 4pm-light meal using foods from low fibre diet allowed list
Following your tea-time meal even if you are hungry, do not eat any solid food after 4pm because this may affect how well your bowel prep works. Your bowel must be completely empty to ensure we have clear views during your endoscopy procedure.
You may drink clear fluids throughout the day. This should preferably be water, but you can also have tonic water, tea or coffee without milk, soft drinks (non-fizzy) including squash (no red or blackcurrant), Bovril, clear fruit juices without pulp/bits, for example clear apple juice.
Avoided clear fruit juices unless your blood glucose level is low.

Your diabetes medications with your evening meal
If you normally take tablet(s) at this time, do not take them.

Guidance on injection treatments
If you take rapid acting insulin i.e. Novorapid® Fiasp® (Aspart) Humalog® (Lispro), Lyumjev™(lispro –aabc), Apidra® (Glulisine) take HALF (½) your usual dose. If you are carbohydrate counting continue as usual.
If you are on a twice-daily regimen take half (½) your usual dose.
If you are on a three-times daily regimen take half (½) your usual dose.
If you take long acting insulin i.e. Levemir® (Determir) or Lantus® Toujeo® or Semglee® or Abasaglar® (Glargine) or Tresiba® (Degludec) take your usual dose at your usual time.
Do not take you usual injection of Exenatide (Byetta®) or Liraglutide (Victoza®) or Lixisenatide (Lyxumia ®).
Postpone taking your once weekly injection of Semaglutide (Ozempic®), Dulaglutide (Trulicity®), Exenatide (Bydureon®) until after the procedure if you usually take this on the same day as the procedure.

1st Dose of bowel preparation: 7pm (see above guidance for specific instructions)

The day of your procedure

Do NOT eat any solid food until after your procedure. You may take clear fluids up to 2 hours before the time of your procedure preferable water.

2nd dose Dose: No later than 5 hours before you procedure appointment time

Continue to check your blood glucose every 2-4 hours if possible.
If you are feeling unwell and/or your blood glucose is over 15mmols check for ketones (if you have been given ketostix or have a blood ketone meter and you have been shown how to use them. Contact the Endoscopy Centre or out of hours telephone number provided in your endoscopy information booklet.
If your blood glucose is 4mmols or below. Follow treatment for hypoglycaemia at the top of this section. 

Your diabetes treatment
Morning
Do NOT take any tablets for your diabetes.
If you take rapid acting insulin i.e. Novorapid®, Fiasp ® (Aspart), Humalog® (Lispro), Lyumjev™(lispro –aabc), Apidra® (Glulisine) do not take this.
If you are on a twice-daily regimen take half (½) your usual dose.
If you are on a three-times daily regimen take half (½) your usual dose.
If you usually take long acting insulin in the morning i.e. Levemir® (Determir) or Lantus® or Toujeo® or Semglee® or Abasaglar® (Glargine) or Insulin Degludec (Tresiba®) take your usual dose.
Do NOT take Exenatide (Byetta®), Liraglutide (Victoza®) or Lixisenatide (Lyxumia® ) on the morning of the procedure.
Postpone taking your once weekly injection of Semaglutide (Ozempic®), Dulaglutide (Trulicity®), Exenatide (Bydureon®) until after the procedure if you usually take this on the same day as the procedure.

If you have an afternoon appointment: At Lunchtime
Do not take any tablets for your diabetes.
If you take rapid acting insulin i.e. Novorapid® Fiasp ® (Aspart) Humalog® (Lispro), Lyumjev™(lispro –aabc), Apidra® (Glulisine) do not take this.
If you are on a three-times daily regimen take half (½) your usual dose.
If you usually take long acting insulin at lunch time i.e. Levemir® (Determir) or Lantus® or Toujeo® or Semglee® or Abasaglar® (Glargine) Insulin Degludec (Tresiba®) take your usual dose.
Check your blood glucose before leaving home. If your blood glucose is below 4mmol/l, follow the instructions on how to treat hypoglycaemia above.

On arrival at the Endoscopy Centre
When you arrive at the Endoscopy Centre your blood glucose will be checked and monitored by the nurse looking after you.

After your procedure
You will be given something to eat and drink unless the endoscopist has indicated otherwise.
Your blood glucose will be checked before going home from the Endoscopy Centre.

If your appointment was before 10am
If you are on a twice-daily insulin regimen take two thirds (⅔) of your usual morning dose with your post procedure food.
If you are on a three-times daily regimen take your usual lunch-time dose.
If you are on a four-times daily insulin regimen take your usual lunch-time dose.
Continue your usual insulin regimen with your evening meal.

If you also take tablets for your diabetes take these with your evening meal as usual. If you take an injection of Exenatide (Byetta®) or Liraglutide (Victoza®) or Lixisenatide(Lyxumia®) restart your injections the day after your procedure.
If you usually take your dose of once weekly injections of Semaglutide (Ozempic®), Dulaglutide (Trulicity®), or Exenatide (Bydureon®) on the day of your procedure please take this after the procedure or when you get home.

Resume your normal diet after going home
and
Resume your usual diabetes treatment with your evening meal.

If your appointment was after 10am
DO NOT take your usual lunchtime diabetes medication
Resume your normal diet after going home
and
Resume your usual diabetes treatment with your evening meal.

This information for patients with diabetes taking tablets for diabetes for Lower Gastrointestinal Endoscopy Procedures MORNING & AFTERNOON appointment (no later than 2pm).

What to do with your medication for your diabetes, diet and bowel preparation medication
This leaflet advises you on how to prepare in the days leading up to your endoscopy procedure, either colonoscopy, sigmoidoscopy or enteroscopy.
It will help you understand:

What to do with your medication for your diabetes
When to take your bowel preparation
The required alterations to your diet to make sure your bowel preparation works and maintain your blood sugar levels

You should:
Have received an appointment in the morning or no later than 2pm in the afternoon-contact endoscopy if you have not
Ensure you DO NOT DRIVE to or from the hospital due to the possibility of low blood glucose readings
Check your blood glucose reading before leaving home if possible
Bring your diabetes tablets with you.
Bring your blood glucose monitor with you (if you have one)

Monitoring is important
Check your blood glucose every 2-4 hours if possible once you start fasting.
If you are feeling unwell and/or your blood glucose is over 15mmols check for ketones
(if you have been given ketostix or have a blood ketone meter and have been shown how to use them.
Contact the Endoscopy Centre or out of hours telephone number provided in your endoscopy information folder).
If your blood glucose is 4mmols or below. Follow treatment for hypoglycaemia guidance below.

Hypoglycaemia guidance
If any of your blood glucose readings are low (below 4 mmol/l), or you feel ‘hypo’ at any time:
Have a cup of FLAT Lucozade (170mls)
or
One 60ml bottle of LIFT drink (lemon & lime)
or
6-7 Dextrosol or Lucozade energy tablets
or
5 Glucotabs
It is advisable to avoid fizzy drinks as this may affect your endoscopy.
Re-check your blood glucose after 15 minutes and if your blood glucose remains less than 4 mmol/l then repeat this treatment.
Once you feel better you will need to follow it up with longer acting carbohydrate foods. Choose one of the following:
2 - 3 Rich Tea or Marie biscuits or 1 slice of white bread.
If your blood glucose remains low despite this treatment for over 30 minutes, please seek medical advice

Seven days before the procedure
If you are taking iron tablets please stop taking them, but continue all other medications including laxatives.
Four days before the procedure
If you are taking any constipating agents (e.g. loperamide, codeine phosphate etc.) stop taking them. Continue with all other medications until your appointment.

Three days before the procedure
Start following low fibre diet (please follow the link for this) for your meals and continue following low fibre diet advice until you start taking your bowel prep medication the evening before your procedure. For the best results in cleansing the bowel a low fibre diet is advised. Eating other foods may affect how well the bowel preparation works to ensure good views of your bowel during your procedure.

Breakfast and Lunch as usual-using foods from low fibre diet allowed list
Take your usual diabetes tablet(s)
Tea-Time (Evening meal) to be completed by 4pm-light meal using foods from low fibre diet allowed list
Diabetes medications with evening meal
Take HALF your usual evening dose of diabetes tablets unless you take only one tablet of any type of diabetic medication, then do not take any.
Following your tea-time meal even if you are hungry, do not eat any solid food after 4pm because this may impact on how the effectively the bowel prep works. Your bowel must be completely empty to ensure we have clear views during your endoscopy procedure

7pm: 1st dose of bowel preparation (using instructions from menus above)

You should not eat any further solid food until after your procedure.
However, you may drink clear fluids throughout the day. This should preferably be water, but you can also have tonic water, tea or coffee without milk, soft drinks (non fizzy) including squash (no red or blackcurrant) clear fruit juices without pulp/bits for example clear apple juice, Bovril.
^ Avoid drinking clear fruit juices unless blood glucose level is low.

The day of your procedure

5 hours before your procedure: 2nd dose of bowel preparation (using instructions from above)

Do NOT eat any solid food until after your procedure
Do NOT take your usual morning dose of diabetes tablets
You may take clear fluids up to 2 hours before the time of your procedure preferable water

On arrival at the Endoscopy Centre
When you arrive at the Endoscopy Centre your blood glucose will be checked and monitored by a nurse

After your procedure
Your blood glucose will be checked before going home from the Endoscopy Centre.
Continue with your usual evening dose of diabetes tablets once you have eaten.