Medical review by Elizabeth Gomez, MSN, FNP-BC
No one enjoys colonoscopy prep, but the method, which incorporates several days of surprising dietary restrictions, could be especially tricky for individuals with diabetes.
While you’re preparing in your colonoscopy, you’ll receive eating guidelines that conflict with every part you’ve ever learned about maintaining a healthy diet with diabetes. Depending in your gastroenterologist’s specifications, you might spend someday each on low-fiber and clear liquid diets. You’ll even be eating many fewer calories than normal. All of those changes have impacts in your blood sugar and will require proactive adjustment of your diabetes medication.
Do you will have a colonoscopy coming up? Read on to study best practices for individuals with diabetes.
Colonoscopy — The Basics
A colonoscopy is a medical procedure wherein a physician examines the liner of the colon (large intestine) for abnormalities, akin to polyps or tumors. These polyps can turn into cancerous and removing them promptly is one of the best method to prevent colorectal cancer, a condition that’s more common in individuals with diabetes.
The present recommendations, set forth by the U.S. Preventive Services Task Force, call for normal colorectal cancer screening between the ages of 45 and 75.
The actual colonoscopy — during which a gastroenterologist sticks a scope up through the anus, beyond the rectum, and into the colon — is performed under anesthesia. Many individuals find the multiple days of preparation worse than the actual procedure. It takes days of careful eating and powerful laxatives to flush fecal matter out of the body in order that your doctor has a transparent view of the intestinal lining.
Blood Sugar Monitoring During Colonoscopy Prep
“You actually need to be paying closer attention to your glucose readings,” says Thomas Grace, MD, the medical director of Ohio’s Blanchard Valley Diabetes Center. Dr. Grace, who has type 1 diabetes himself, advises patients on colonoscopy prep ceaselessly.
Your several days of colonoscopy prep will mean big changes to each what and the way much you eat, which may easily cause blood sugar unpredictability.
Grace told Diabetes Every day that the risks are generally not extreme for colonoscopy patients with diabetes, but that close glucose monitoring — ideally with a continuous glucose monitor (CGM) — is vital. Should you’re aware of your glucose levels, it’s easier to make adjustments. And the steadier your blood sugar, the less likely the medical team will probably be required to administer your insulin or sugar intake through the colonoscopy procedure.
The most important fear, says Grace, is low blood sugar. “We don’t want you going low. Anything we will do to assist prevent that hypoglycemia, we’re going to try this.”
It’s especially necessary for individuals with diabetes — especially people who use any drugs related to hypoglycemia, particularly insulin and sulfonylureas — to at all times keep a source of sugar on the ready.
In order to not disrupt the colonoscopy prep, that sugar source must be a transparent beverage: “I need my patients to have a transparent juice, soda or Gatorade around in case their blood sugars are running low.” Fixing a hypo with anything threatens to cancel the colonoscopy, an expensive hassle for everybody involved.
The Low-Fiber Eating regimen
The primary stage of colonoscopy prep normally requires you to adopt a low-fiber food plan.
Should you’re already eating a healthy diabetes food plan — an eating pattern that avoids added sugars, refined grains, and other highly processed foods — you’ll be really useful to eat among the very foods you normally don’t allow yourself.
Based on the Mayo Clinic, a low-fiber food plan asks people to eat the sort of nutritionally meager foods we’re normally alleged to keep away from, including white rice and pasta, low-fiber bread and biscuits, and processed fruit products like juice, applesauce, and canned peaches. Meanwhile, colonoscopy preppers should not eat healthy whole ingredients like nuts, seeds, brown rice, quinoa, whole grain bread, beans, lentils, and most vegatables and fruits.
Should you’re watching your carb and sugar intake, what are you alleged to do? For one thing, a low-fiber food plan also allows for the consumption of eggs, lean meats, and dairy. You may also have some soft, well-cooked vegetables, akin to carrots or green beans. The UK’s National Health Service recommends that folks with diabetes aim to have the identical amount of carbohydrates that they customarily do.
Some doctors may also advise patients with diabetes to tolerate a better blood sugar for a day or two. A couple of days of suboptimal eating is not going to cause any long-term harm.
“Sooner or later of glucose readings which might be a bit of bit higher — permissive hyperglycemia — is way higher than having a severe hypoglycemic event,” says Grace. “It’s just safer.”
It’s probably best to debate the main points of your low-fiber eating plan together with your gastroenterologist. There’s also plenty of recommendation on the Diabetes Every day forums, where regular people have been sharing details of their colonoscopy prep experiences for years.
The Clear Liquid Eating regimen
The day before your procedure, you’ll probably switch to a food plan of clear liquids. This can will let you ingest some calories and stay hydrated without depositing any recent fecal matter in your colon.
Apart from water and zero-calorie beverages akin to coffee or tea, the Mayo Clinic recommends among the following foods: clear gelatin (with or without sugar), bone broth and clear soup, pulp-free juice, soda, sports drinks, and ice pops.
It’s practically inconceivable to eat your fill on a transparent liquid food plan. You’ll eat virtually no fat, and it’s hard to seek out protein sources. Refined and added sugars represent two of the one calorie sources that you simply’re allowed to have.
Even when you eat more sugar than usual, you may expect to be hungry. Should you’re not enthusiastic about a day of crash weight-reduction plan, ask your doctor about high-protein gelatin and clear protein shakes — they could have the ability to recommend a product that works for you.
It may be smart to have each sugary and sugar-free options on the ready, so you may reply to the changes in your blood glucose levels.
At the identical time, you might be required to drink vast amounts of laxative beverages. These solutions, akin to GoLYTELY, have zero calories and include loads of electrolytes. There are lots of different colonoscopy prep kits and laxatives; your gastroenterologist may have their favorite and will not initially give you a selection. But when you’re curious, On a regular basis Health has explored the choices: Selecting a Colonoscopy Prep.
The collision of your diabetes medication, colonoscopy prep, and the procedure itself increases the chance of quite a lot of bad health outcomes, including hypoglycemia, lactic acidosis, and kidney injury. Working rigorously together with your doctor, you’ll have to cut back or stop taking a few of your medications ahead of your colonoscopy.
A 2022 review offers some standard recommendations:
- Metformin: Stop taking when the clear liquid food plan begins, and resume when you’re back to eating normal meals after the procedure.
- GLP-1 receptor agonists (akin to Ozempic and Trulicity): Stop taking when the clear liquid food plan begins, and resume when you’re back to eating normal meals after the procedure. In case your regular weekly injection is scheduled during your colonoscopy prep period, hold off until you’re back to eating normally.
- DPP-4 inhibitors (akin to Januvia): Stop the morning of the procedure and resume that evening.
- SGLT-2 inhibitors (akin to Jardiance and Invokana): Stop taking three days before the procedure, and resume when you’re back to eating normal meals and are adequately hydrated.
- Sulfonylureas: Stop taking the day before the procedure and resume when you’re back to eating normal meals.
Insulin, the diabetes drug with the best risk of hypoglycemia, and an absolute necessity for individuals with type 1, requires special attention. Please speak to your doctor, because the next are only starting points:
- Rapid insulin: People who use an insulin-to-carb ratio to find out how much rapid insulin to make use of for meals can proceed to follow their normal dosing strategy. Those who use fixed doses for every meal may have to chop their usual dose substantially through the clear liquid phase of prep.
- Basal insulin: Starting the day before the procedure, patients will probably be asked to chop their basal insulin dose by 20 to 50 percent, depending on the insulin they use and the sort of diabetes they experience.
Grace reports that his patients using automated insulin delivery (closed-loop systems that use CGM readings to mechanically adjust insulin doses administered by an insulin pump) don’t have to do anything; their system will naturally adjust to their changing insulin requirements.
Other Special Considerations for People With Diabetes
It can be crucial that your gastroenterologist knows that you will have diabetes. Consider it your responsibility to make certain that they’re aware.
Based on a 2022 review, diabetes “is a predictive factor for inadequate bowel cleansing,” meaning that folks with diabetes usually tend to need a second colonoscopy because their colon wasn’t clean enough for the doctor to perform an evaluation. Diabetic neuropathy, for instance, may slow the digestive system, causing a regular prep protocol to fail. In case your gastroenterologist knows that you will have diabetes, they could recommend modifications, akin to a special sort of laxative or a customized food plan plan.