Medical assessment by Elizabeth Gomez, MSN, FNP-BC
Nobody enjoys colonoscopy prep, however the course of, which incorporates a number of days of surprising dietary restrictions, could be particularly difficult for individuals with diabetes.
When you’re making ready for your colonoscopy, you’ll obtain consuming tips that battle with every part you’ve ever discovered about maintaining a healthy diet with diabetes. Depending in your gastroenterologist’s specs, it’s possible you’ll spend at some point every on low-fiber and clear liquid diets. You’ll even be consuming many fewer energy than regular. All of those modifications have impacts in your blood sugar and should require proactive adjustment of your diabetes medicine.
Do you will have a colonoscopy arising? Read on to find out about greatest practices for individuals with diabetes.
Colonoscopy — The Basics
A colonoscopy is a medical process by which a physician examines the liner of the colon (massive gut) for abnormalities, comparable to polyps or tumors. These polyps can grow to be cancerous and eradicating them promptly is one of the simplest ways to stop colorectal most cancers, a situation that’s more common in individuals with diabetes.
The present suggestions, set forth by the U.S. Preventive Services Task Force, name for common colorectal most cancers screening between the ages of 45 and 75.
The precise colonoscopy — throughout which a gastroenterologist sticks a scope up by the anus, past the rectum, and into the colon — is carried out below anesthesia. Many individuals discover the a number of days of preparation worse than the precise process. It takes days of cautious consuming and highly effective laxatives to flush fecal matter out of the physique in order that your physician has a clear view of the intestinal lining.
Blood Sugar Monitoring During Colonoscopy Prep
“You really 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 kind 1 diabetes himself, advises sufferers on colonoscopy prep incessantly.
Your a number of days of colonoscopy prep will imply large modifications to each what and the way a lot you eat, which may simply trigger blood sugar unpredictability.
Grace instructed Diabetes Daily that the dangers are usually not excessive for colonoscopy sufferers with diabetes, however that shut glucose monitoring — ideally with a steady glucose monitor (CGM) — is vital. If you’re conscious of your glucose ranges, it’s simpler to make changes. And the steadier your blood sugar, the much less doubtless the medical workforce might be required to handle your insulin or sugar consumption through the colonoscopy process.
The greatest worry, says Grace, is low blood sugar. “We don’t want you going low. Anything we can do to help prevent that hypoglycemia, we’re going to do that.”
It’s particularly necessary for individuals with diabetes — particularly those who use any medicine related to hypoglycemia, notably insulin and sulfonylureas — to at all times maintain a supply of sugar on the prepared.
So as not to disrupt the colonoscopy prep, that sugar supply must be a clear beverage: “I want my patients to have a clear juice, soda or Gatorade around in case their blood sugars are running low.” Fixing a hypo with anything threatens to cancel the colonoscopy, an costly problem for everybody concerned.
The Low-Fiber Diet
The first stage of colonoscopy prep often requires you to undertake a low-fiber weight-reduction plan.
If you’re already consuming a wholesome diabetes weight-reduction plan — an consuming sample that avoids added sugars, refined grains, and different extremely processed meals — you’ll be advisable to eat among the very meals you usually don’t enable your self.
According to the Mayo Clinic, a low-fiber weight-reduction plan asks individuals to eat the kind of nutritionally meager meals we’re often supposed to avoid, together with white rice and pasta, low-fiber bread and biscuits, and processed fruit merchandise like juice, applesauce, and canned peaches. Meanwhile, colonoscopy preppers ought to not eat wholesome entire substances like nuts, seeds, brown rice, quinoa, entire grain bread, beans, lentils, and most vegetables and fruit.
If you’re watching your carb and sugar consumption, what are you supposed to do? For one factor, a low-fiber weight-reduction plan additionally permits for the consumption of eggs, lean meats, and dairy. You may have some gentle, well-cooked greens, comparable to carrots or inexperienced beans. The United Kingdom’s National Health Service recommends that folks with diabetes intention to have the identical quantity of carbohydrates that they typically do.
Some medical doctors can even advise sufferers with diabetes to tolerate a larger blood sugar for a day or two. A couple of days of suboptimal consuming won’t trigger any long-term hurt.
“One day of glucose readings that are a little bit higher — permissive hyperglycemia — is way better than having a severe hypoglycemic event,” says Grace. “It’s just safer.”
It’s in all probability greatest to talk about the small print of your low-fiber consuming plan along with your gastroenterologist. There can be loads of recommendation on the Diabetes Daily boards, the place common individuals have been sharing particulars of their colonoscopy prep experiences for years.
The Clear Liquid Diet
The day earlier than your process, you’ll in all probability change to a weight-reduction plan of clear liquids. This will enable you to ingest some energy and keep hydrated with out depositing any new fecal matter in your colon.
Aside from water and zero-calorie drinks comparable to espresso or tea, the Mayo Clinic recommends among the following meals: clear gelatin (with or with out sugar), bone broth and clear soup, pulp-free juice, soda, sports activities drinks, and ice pops.
It’s virtually unimaginable to eat your fill on a clear liquid weight-reduction plan. You’ll eat nearly no fats, and it’s not simple to discover protein sources. Refined and added sugars symbolize two of the one calorie sources that you simply’re allowed to have.
Even should you eat extra sugar than normal, you possibly can anticipate to be hungry. If you’re not enthusiastic about a day of crash weight-reduction plan, ask your physician about high-protein gelatin and clear protein shakes — they might have the opportunity to suggest a product that works for you.
It is perhaps good to have each sugary and sugar-free choices on the prepared, so you possibly can reply to the modifications in your blood glucose ranges.
At the identical time, it’s possible you’ll be required to drink huge quantities of laxative drinks. These options, comparable to GoLYTELY, have zero energy and embrace loads of electrolytes. There are many alternative colonoscopy prep kits and laxatives; your gastroenterologist can have their favourite and should not initially give you a alternative. But should you’re curious, Everyday Health has explored the choices: Choosing a Colonoscopy Prep.
Adjusting Medication
The collision of your diabetes medicine, colonoscopy prep, and the process itself will increase the chance of a number of unhealthy well being outcomes, together with hypoglycemia, lactic acidosis, and kidney harm. Working rigorously along with your physician, you should have to scale back or cease taking a few of your medicines forward of your colonoscopy.
A 2022 review gives some commonplace suggestions:
- Metformin: Stop taking when the clear liquid weight-reduction plan begins, and resume when you’re again to consuming regular meals after the process.
- GLP-1 receptor agonists (comparable to Ozempic and Trulicity): Stop taking when the clear liquid weight-reduction plan begins, and resume when you’re again to consuming regular meals after the process. If your common weekly injection is scheduled throughout your colonoscopy prep interval, maintain off till you’re again to consuming usually.
- DPP-4 inhibitors (comparable to Januvia): Stop the morning of the process and resume that night.
- SGLT-2 inhibitors (comparable to Jardiance and Invokana): Stop taking three days earlier than the process, and resume when you’re again to consuming regular meals and are adequately hydrated.
- Sulfonylureas: Stop taking the day earlier than the process and resume when you’re again to consuming regular meals.
Insulin, the diabetes drug with the best threat of hypoglycemia, and an absolute necessity for individuals with kind 1, requires particular consideration. Please converse to your physician, as a result of the next are solely beginning factors:
- Rapid insulin: People that use an insulin-to-carb ratio to decide how a lot speedy insulin to use for meals can proceed to comply with their regular dosing technique. Those that use fastened doses for every meal can have to minimize their normal dose considerably through the clear liquid section of prep.
- Basal insulin: Beginning the day earlier than the process, sufferers might be requested to minimize their basal insulin dose by 20 to 50 %, relying on the insulin they use and the kind of diabetes they expertise.
Grace studies that his sufferers utilizing automated insulin supply (closed-loop programs that use CGM readings to routinely modify insulin doses administered by an insulin pump) don’t want to do something; their system will naturally modify to their altering insulin necessities.
Other Special Considerations for People With Diabetes
It is necessary that your gastroenterologist is aware of that you’ve diabetes. Consider it your accountability to guarantee that they’re conscious.
According to a 2022 review, diabetes “is a predictive factor for inadequate bowel cleansing,” which means that folks with diabetes are extra doubtless to want a second colonoscopy as a result of their colon wasn’t clear sufficient for the physician to carry out an analysis. Diabetic neuropathy, for instance, might sluggish the digestive system, inflicting a commonplace prep protocol to fail. If your gastroenterologist is aware of that you’ve diabetes, they might suggest modifications, comparable to a particular kind of laxative or a personalized weight-reduction plan plan.
