Please select a type of Diabetes above to get more information
2 Days before procedure
Day before procedure
Morning of procedure
Hospital pre-operative care
Hospital post-operative care
Post-discharge
Follow a low-residue dietExpect lower glucose levels, so reduce insulin doses to avoid hypoglycemia:
Check glucose levels pre-meals, bedtime and 2am
Follow the instructions for the bowel prepFollow the low-residue dietIf glucose levels are lower again, plan to reduce insulin doses:
Check glucose levels pre-meals, bedtime and 2amCheck ketones before lunchtime
Eat a light breakfast before 6am, then skip lunchTake the reduced dose of Lantus, Levemir or ToujeoGive ½ usual breakfast dose of rapid-acting insulin, then skip the lunch time dose If taking pre-mixed insulin, take ½ usual morning doseMonitor glucose levels before breakfast & after 2 hoursIf glucose level falls <4 mmol/L, treat with one of:
Report the hypoglycaemia on arrival at hospital
Monitor glucose level on arrivalIdeal perioperative glucose levels are 5 – 10 mmol/L, but levels 4 – 12 mmol/L are acceptableProceed to colonoscopy if glucose levels are 4 – 12 mmol/L
If glucose level is <4 mmol/L, manage hypoglycemia
If glucose level is >12 mmol/L, manage hyperglycemia
If glucose level <12 mmol/L, proceed to surgeryIf glucose level >12 mmol/L, commence insulin infusion
Treat diabetic ketoacidosis
Postpone surgeryRefer patient to ICU or Endocrinologist for admission
Proceed to colonoscopy when:
Reschedule colonoscopy
Monitor glucose levels every 1 hour until patient is eatingWhen patient is eating without vomiting, they can eat and resume their usual insulin doses If glucose level is 4 – 12 mmol/L, patient can be safely discharged
If glucose level is <4 mmol, treat hypoglycemia
If glucose level is >15 mmol/L, treat hyperglycemia
After 1 hour,
Patient will need someone to drive them home and car for them. There is a risk of later hypoglycaemia, particularly if 2nd dose of rapid-insulin is required
Refer patient to ICU or Endocrinologist for admission
Resume usual dietRestart usual insulin doses when eatingMonitor glucose levels regularly: before breakfast, lunch & dinner, at bedtimeMild hyperglycemia is common for the first few days post-operatively, so aim to:
Preparing your patient for discharge
Follow a low-residue diet and bowel prep according to instructionsExpect lower glucose levels, so reduce insulin doses to avoid hypoglycemia:
Eat a light breakfast before 6am, then skip lunchContinue reduced basal rates from day before colonoscopy Reduce the bolus dose according to the carbohydrate content in breakfast, then withhold the lunch time bolus
Monitor glucose levels before breakfast & after 2 hoursIf glucose level falls <4 mmol/L, treat with one of:
Monitor glucose level on arrivalIdeal perioperative glucose levels are 5 – 10 mmol/L, but levels 4 – 12 mmol/L are acceptableProceed to surgery if glucose levels are 4 – 12 mmol/L
If glucose level is >12 mmol/L, manage hyperglycemiaStep 1: Check that the pump is runningCheck the tubing for kinks and injection site for leaksStep 2: Check capillary ketones
Step 1: Check that the pump is running or kinked tubing
Step 2: Check capillary blood for ketones
If the pump is running:
Treat the DKA:
Postpone colonoscopyReschedule when diabetes is stable. Consider pre-operative admission to optimize glycaemic control next time
Monitor glucose levels every 1 hour until patient is eatingWhen patient is eating without vomiting, they can eat and give boluses and resume their usual insulin settings If glucose level is 4 – 12 mmol/L, patient can be safely discharged
If glucose level is >12 mmol/L, treat hyperglycemia
If glucose level is >12 mmol/L, give another correction bolus
If glucose level is 4 – 12 mmol/L, plan to discharge patient on their insulin settings
Give a correction bolus
Increase the basal rate by 50%Ensure Dextrose fluids are running:
If glucose is >12 mmol/L
If glucose level is 4 – 12 mmol/L
If your patient can eat, eat some low-GI carbohydrate with bolus for that serve of carbohydrateEg. Glass of milkTub of yoghurt1 slice of bread2 dry, sweet biscuits
If your patient can eat, eat some low-GI carbohydrate with bolus for that serve of carbohydrateEg. Glass of milkTub of yoghurt1 slice of bread
Treat the Diabetic Ketoacidosis:
Resume usual dietRestart usual insulin settingsMonitor glucose levels regularly: before breakfast, lunch & dinnerMild hyperglycemia is common for the first few days post-operatively, so aim to:
2 days before procedure
Hospital pre-procedure care
Follow the low-residue diet recommended by the endoscopy unitTake one dose of Epsom salts, 15 g dissolved in 1 glass of water
Monitor glucose levels pre-meals and at bedtimeContinue taking usual diabetes medications
Follow the instructions for the bowel prepTake second dose of Epsom salts, 15 g dissolved in 1 glass of water
Monitor glucose levels pre-meals and at bedtimeWithhold usual diabetes tablets and injectables
Eat a light breakfast by 6am, then skip lunchTake usual morning diabetes tabletsWithhold sulphonylureaWithhold exenatide Monitor glucose levels before breakfast & after 4 hoursIf glucose level falls <4 mmol/L, treat with one of:
Report the hypoglycaemic event on arrival at hospital
Monitor glucose level on arrivalIdeal peri-procedure glucose levels are 5 – 10 mmol/L, but levels 4 – 12 mmol/L are acceptableProceed to colonoscopy if glucose levels are 4 – 12 mmol/L
If glucose level is >12 mmol/L, Step 1: Give a dose of Novorapid, dose = Weight ÷ 12Step 2: Recheck capillary glucose in 1 hour
Monitor glucose levels every 1 hour until patient is eatingWhen patient is eating without vomiting, they can eat and give boluses and resume their usual insulin settings If glucose level is 4 – 15 mmol/L, patient can be safely discharged
If glucose level is >15 mmol/L, treat hyperglycemia Step 1: Give Novorapid bolus, dose = Weight ÷ 12 Step 2: Recheck blood glucose level after 1 hour
Refer patient to the Endocrinology team or physician
Follow the low-residue diet recommended by the endoscopy unitTake one dose of Epsom salts, 15 g dissolved in 1 glass of water Monitor glucose levels pre-meals and at bedtimeContinue taking usual diabetes medicationsInsulin doses may need to be reduced according to glucose levels:
Follow the instructions for the bowel prepTake second dose of Epsom salts, 15 g dissolved in 1 glass of water Monitor glucose levels pre-meals and at bedtimeWithhold all diabetes tablets and injectablesIf glucose levels are stable, continue the reduced doses given yesterdayIf glucose levels are lower (below 5 mmol/L), reduce the insulin doses:
Monitor glucose levels on waking Skip breakfastTake usual morning diabetes tabletsWithhold exenatide, liraglutide or dulaglutide
Take the reduced dose of Lantus, Levemir or ToujeoWithhold usual breakfast dose of rapid-acting insulin eg. Apidra, Humalog or Novorapid
If taking pre-mixed insulin, take ½ usual morning dose
Eat a light breakfast by 6am, then skip lunchTake usual morning diabetes tabletsWithhold sulphonylureaWithhold exenatide, liraglutide or dulaglutide
Monitor glucose levels before breakfast & after 4 hoursIf glucose level falls <4 mmol/L, treat with one of:
Monitor glucose levels every 1 hour until patient is eatingWhen patient is eating without vomiting, they can eat and their usual insulin doses If glucose level is 4 – 15 mmol/L, patient can be safely discharged
If glucose level is >15 mmol/L, treat hyperglycemia Step 1: Give usual dose of rapid acting insulin with a meal, orUse correction dose of rapid-acting insulin: 1 unit to lower glucose by 2 mmol/L Step 2: Recheck blood glucose level after 1 hour
Resume usual dietRestart usual tablets, injectables and insulinMonitor glucose levels regularly: before breakfast, lunch & dinner
Mild hyperglycemia is common for the first few days post-operatively, so aim to:
Manage constipation with regular aperients