iii) Guidelines for people with diabetes undergoing outpatient upper GI endoscopy
1. General Advice
You need to be fasted before the procedure and therefore to avoid low blood sugar you will need to adjust your medication according to the timing of your appointment. As a result your diabetes control may not be optimal but this is only temporary and will be back to your usual within 24-48 hours.
Patients on insulin would need to monitor their blood sugars. If you are on tablets and you don’t have a blood glucose monitor, don’t worry.
If you have symptoms of hypo (sweaty, shaky, heart racing), drink one of the sugar containing fluids mentioned in the leaflet. We will try and arrange for you to have a morning appointment where possible; alternatively you will be the first on the afternoon list. Please remind the nursing staff that you have diabetes when you arrive.
If you have any questions about your appointment, please contact the number on your appointment letter. If you need advice about your diabetes medications, please contact the Diabetes Specialist Nurses at least two weeks prior to your appointment.
- How to manage your medications
Morning appointment - for people on tablets for diabetes
You should have nothing to eat after midnight but you may have drinks up to 6am.
If you are on sulphohylureas i.e. gliclazide (Diamicron), glipizide (Glibenese), glimepiride (Amaryl), Glibenclamide (Daonil) or tolbutamide
Day before the procedure: if you take a dose at teatime, then take half your dose in the evening before the procedure. If you are on a small dose e.g. Gliclazide 2.5mg or Glimepiride 1mg, then simply omit the dose.
Day of the procedure: Please miss all your tablets for diabetes until after the procedure. Recommence as usual once you can eat a regular meal.
If you are on Metformin (Glucophage), pioglitazone (Actos, Competact), rosiglitazone (Avandia, Avandiamet), acarbose (Glucobay), repaglinide or nateglinide
Day before the procedure: you can take your tablets as usual.
Day of the procedure: Please miss all your tablets for diabetes until after the procedure. Recommence as usual once you can eat a regular meal.
Afternoon appointment - for people on tablets for diabetes
If you are on gliclazide (Diamicron), glipizide (Glibenese), glimepiride (Amaryl), Glibenclamide (Daonil), tolbutamide or metformin (Glucophage), pioglitazone (Actos, Competact), rosiglitazone (Avandia, Avandiamet), acarbose (Glucobay), repaglinide or nateglinide
Have an early breakfast. You should havenothing to eat or drink after 8 am but you can have small amounts to drink up to 2 hrs before your test
Day before the procedure: You can take your tablets as usual.
Day of the procedure: Please miss all tablets for diabetes until after the procedure. Recommence as usual once you can eat a regular meal.
Morning appointment - for people on insulin
You should have nothing to eat after midnight but you may have drinks up to 6 am.
A) If you take an injection of long acting insulin in the morning (Glargine (Lantus), Determir (Levemir), Isophane (Insulatard, Humulin I).
The day before your procedure take your usual dose.
On the day of your procedure take 2/3 rd your usual dose on the morning of your test. For e.g. if you take 24 units of insulin take 16 units.
Please see Section C if you take short acting insulin as well.
B) If you take an injection of long acting insulin in the evening (Glargine (Lantus), Determir (Levemir), Isophane (Insulatard, Humulin I).
The day before your procedure take 2/3 rd your usual dose in the evening. For e.g. if you take 24 units of insulin take 16 units.
On the day of your procedure (after procedure) take your usual dose.
Please see Section C if you take short acting insulin as well.
C) If you are on several injections of short acting insulin (Novorapid, Humalog, Humulin S, and one or two injections of long acting insulin morning (Glargine (Lantus), Determir (Levemir), Isophane (Insulatard, Humulin I). The day before your procedure take your usual dose of short acting insulin .On the day of the procedure omit the morning short acting insulin. Take it as soon you are able to have a meal after your procedure.
Please see section A and /or B for advice about your long acting insulin.
D) If you take two injections of insulin for example morning and evening with mixed insulin (Humalog Mix 25, Humulin M3, Novomix 30 or Human Mixtard 30)
The day before your test take usual dose in the morning and 2/3rd dose in the evening. For e.g. if you take 24 units of insulin take 16 units.
On the day of your test take 1/3 rd of your usual dose before the test. For example, if you take 24 units of insulin, take 8 units of insulin in the morning. Take another 1/3rd of the dose as soon as you are able to have a regular meal.
Afternoon appointment – for people on insulin
Have an early breakfast. You should havenothing to eat or drink after 8 am but you can have small amounts to drink up to 2 hrs before your test
A) If you take an injection of long acting insulin in the morning (Glargine (Lantus), Determir (Levemir), Isophane (Insulatard, Humulin I)
The day before your procedure take your usual dose.
On the day of your procedure take 1/2 your usual dose on the morning of your test. For e.g. if you take 24 units of insulin take 12 units.
Please see Section C if you take short acting insulin as well.
B) If you take an injection of long acting insulin in the evening (Glargine (Lantus), Determir (Levemir), Isophane (Insulatard, Humulin I).
The day before your procedure take 1/2 your usual dose in the evening. For example, if you take 24 units of insulin take 12 units.
On the day of your procedure (after procedure) take your usual dose.
Please see Section C if you take short acting insulin as well.
C) If you are on several injections of short acting insulin (Novorapid, Humalog, Humulin S, and one or two injections of long acting insulin (Glargine (Lantus), Determir (Levemir), Isophane (Insulatard, Humulin I).
The day before your procedure and the morning of your procedure take your usual dose of short acting insulin if you are able to take a regular meal.
On the day of the procedure omit your afternoon dose of short acting insulin. Take it once you are able to have a regular meal after your procedure.
Please see section A and /or B for advice about your long acting insulin.
D) If you take two injections of insulin (for example morning and evening with mixed insulin (Humalog Mix 25, Humulin M3, Novomix 30 or Human Mixtard 30)
The day before your test take your usual dose in the morning & in the evening.
On the day of your test take 1/3 rd of your usual dose before the test. For example if you take 24 units of insulin, take 8 units of insulin in the morning. Take your usual evening dose with your tea.
3. Correction of hypo
If you have a hypo i.e. blood glucose less than 4 mmol/L, then suck 3 dextrose sweets initially followed by another 3 if you do not feel any better. You can also drink 80- 150 mls of lucozade, sweetened squash or fruit juices. Make sure you tell the medical staff if you have a hypo.
Take your insulin, diabetes tablets, blood glucose monitor, and insulin injecting equipment with you. Take a packed meal to avoid delay in administering tablets/insulin.
If you have Type 1 diabetes, you should check your urine for ketones if your blood sugars are higher than 17mmol/L.
4. What to do after your procedure?
The nursing staff will inform you when it is safe to eat and drink. Take your tablets/ insulin as advised above when you are able to have a regular meal.
When you get home, your sugar levels may vary for a short time, but this should quickly return to your usual.
Contact telephone numbers
Diabetes Nurse Specialist Aberdeen Royal Infirmary 01224 559364
Diabetes Nurse Specialist Woolmanhill 01224 555491
If calling out of hours, please contact Ward 27/28 (Department of Diabetes) Aberdeen Royal Infirmary 01224 551042
You can also contact your GP for further advice.