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Lower Endoscopy Diabetic Handout

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Diabetic and Injectable Weight Loss Medication Instructions for Lower Endoscopy

(Colonoscopy, Flexible Sigmoidoscopy, & Endoscopic Ultrasound) 

Review these instructions at least one week before your procedure as some diabetic and injectable weight loss medications may need to be stopped 7 days prior to your procedure. 

For people taking injectable medications for weight loss only, please refer to the GLP-1 agonists sections on the below tables for medication holding instructions.

For people taking medication for diabetes, please refer to the below tables for medication holding instructions. Do not make up or “double up” on any missed medication after the procedure. Please call our office if you have any questions about these instructions. If your medication is not listed or if you have had any changes to your medication, contact your endocrinologist or primary care provider for instructions. 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. For this reason, please review the instructions and tips listed below. 

  • Check your blood glucose level before all meals, at bedtime on the preparation day and on the day of the procedure.
  • Check your blood glucose if at any time you have symptoms of low blood glucose or very high blood glucose. 
  • If you are using a 2-day or 3-day prep, please follow these instructions for each day you are on the clear liquid diet. (See clear liquid diet instructions included in your packet). 
  • Aim for 45 grams of carbohydrates at meals and 15-30 grams of carbohydrates for snacks. Getting plenty of protein is also important. Clear protein drinks such as Boost Breeze, Ensure Clear, Atkins Lift, or Premier Protein Clear are encouraged but not required. These are often found in the nutritional supplement aisle or online. 
  • If your blood sugar is low, you may have up to 4 oz of a clear sugar liquid such as apple juice up to 2 hours prior to your procedure. 
  • If you use a CGM (continuous glucose monitor), continue to use it before, during and after the procedure.

MEDICATION

  • GLP-1 agonists (weekly): Dulaglutide (Trulicity) Semaglutide injection (Ozempic, Wegovy) Tirzepatied (Mounjaro)

7 DAYS BEFORE PROCEDURE

  • If you are taking for diabetes or weight loss, stop taking 7 days prior to your procedure.

DAY OF PROCEDURE

  • Resume once meals have resumed. Once weekly injectable should be taken the evening of the procedure if it was held before the procedure.

MEDICATION

Biguanides:

  • Metformin (Glucophage) 
  • Metformin ER (Glumetza)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Stop taking once clear liquid diet starts.

DAY OF PROCEDURE

  • Resume once meals have resumed.

MEDICATION

  • Thiazolidinediones: Pioglitazone (Actos)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Continue as normal.

DAY OF PROCEDURE

  • Resume once meals have resumed.

MEDICATION

DPP-4 inhibitors

  • Alogliptin (Nesinia)
  • Lingaliptin (Trajenta)
  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Continue as normal.

DAY OF PROCEDURE

  • Stop morning of the procedure. Resume the evening after the procedure. 

MEDICATION

SGLT-2 inhibitors:

  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga)
  • Empagliflozin (Jardiance)

3 DAYS BEFORE PROCEDURE

  • Stop Taking.

2 DAYS OF PROCEDURE

  • Already stopped.

1 DAYS BEFORE PROCEDURE

  • Already stopped.

DAY OF PROCEDURE

  • Resume once meals and adequate hydration have resumed.

MEDICATION

Sulfonylureas:

  • Gliclazide (Diamicron)
  • Gliclazide MR (Diamicron MR)
  • Glimepiride (Amaryl)
  • Glyburide
  • (Diabeta/Micronase/Glynase)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Stop taking. 

DAY OF PROCEDURE

  • Resume once meals have resumed.

MEDICATION

Meglitinides:

  • Nateglinide (Starlix)
  • Repaglinide
  • (Gluconorm/Prandin)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Stop taking once clear liquid diet starts. 

DAY OF PROCEDURE

  • Resume once meals have resumed.

MEDICATION

  • iInsulins-Rapid/Short acting: Aspart (Novorapid/Trurapi) 
  • Faster insulin aspart (Fiasp) 
  • Glulisine (Apidra) 
  • Lispro (Admelog/Humalog) 
  • Regular human insulin (Humulin R/Novolin R) 
  • Human bio synthetic insulin (Entuzity)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • If taking a fixed dose, take 50% of the usual dose once the clear liquid diet starts. If insulin dosing is based on insulin to carbohydrate ratio, continue typical rapid acting insulin dosing. 

DAY OF PROCEDURE

  • Resume once meals have resumed.

MEDICATION

Insulin-Intermediate acting:

  • NPH (Novolin ge NPH)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Take 80% of the normal dose.

DAY OF PROCEDURE

  • Take 50% of the normal dose the morning of the procedure. Once eating regular meals, resume normal dose at next scheduled dose.

MEDICATION

Insulin-First-generation Basal:

  • Glargine (Lantus/Basaglar)
  • Detemir (Levemir)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Take 80% of the normal dose.

DAY OF PROCEDURE

  • Take 50% of the normal dose the morning of the procedure. Once eating regular meals, resume normal dose at next scheduled dose

MEDICATION

Insulin-Secondgeneration Basal:

  • Glargine U300 (Toujeo/Toujeo Doublestar)
  • Degludec U100 and U200 (Tresbia)

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • Type 1 Diabetic patients should take 80% of their normal dose and Type 2 Diabetic patients should take 50% of their normal dose. 

DAY OF PROCEDURE

  •  If insulin dose is before the procedure Type 1 diabetic patients should take 80% of their normal dose, and Type 2 diabetic patients should take 50% of their normal dose. Once eating regular meals, resume normal dose at next scheduled dose.

MEDICATION

For patients wearing an insulin pump:

3 DAYS BEFORE PROCEDURE

  • Continue as normal.

2 DAYS OF PROCEDURE

  • Continue as normal.

1 DAYS BEFORE PROCEDURE

  • For automatic insulin pumps, continue as normal. If on a basal insulin pump, adjust basal insulin rate to 80% of your normal rate once clear liquid diet begins.

DAY OF PROCEDURE

  • Once meals have resumed, insulin pump dosing should be resumed at the normal dose and interval.

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