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No one enjoys a colonoscopy setup, but the process, which includes several days of unusual dietary restrictions, can be especially challenging for people with diabetes.
When you prepare for your colonoscopy, you’ll receive eating guidelines that go against everything you’ve learned about healthy eating with diabetes. Depending on your gastroenterologist’s specifications, you may spend one day on a low-fiber, clear liquid diet. You’ll also eat a lot fewer calories than usual. All of these changes have effects on blood sugar and may require a proactive adjustment of diabetes medications.
Do you have a colonoscopy coming up? Read on to learn about best practices for people with diabetes.
Colonoscopy – the basics
A colonoscopy is a medical procedure in which a doctor examines the lining of the colon (large intestine) for any abnormalities, such as polyps or tumors. These polyps can become cancerous and promptly removing them is the best way to prevent colorectal cancer, a condition more common in people with diabetes.
The current recommendations, set by the US Preventive Services Task Force, call for regular screenings for colorectal cancer between the ages of 45 and 75.
The actual colonoscopy — during which a gastroenterologist inserts an endoscope through the anus, behind the rectum, and into the colon — is performed under anesthesia. Many people find that multiple days of preparation are worse than the actual procedure. It takes days of careful eating and strong laxatives to flush the stool out of the body so that your doctor can have a clear view of the lining of your intestines.
Monitor your blood sugar while preparing for a colonoscopy
“You really need to pay closer attention to your glucose readings,” says Thomas Grace, MD, medical director of the Blanchard Valley Diabetes Center in Ohio. Dr. Grace, who has type 1 diabetes himself, advises patients to prepare for frequent colonoscopies.
Several days of preparing for a colonoscopy will mean big changes in both the type and amount of food you eat, which can easily lead to unpredictability of your blood sugar.
Grace told Diabetes Daily that the risks are generally not severe for colonoscopy patients with diabetes, but that close glucose monitoring — ideally with a continuous glucose monitor (CGM) — is key. If you are aware of your glucose levels, it is easier to make adjustments. And the higher your blood sugar level, the less likely the medical team will ask you to administer insulin or sugar during the colonoscopy procedure.
The biggest fear, Grace says, is low blood sugar. “We don’t want you to go low. Anything we can do to help prevent hypoglycemia, we will do that.”
It’s especially important for people with diabetes — especially those using any drugs associated with hypoglycemia, especially insulin and sulfonylureas — to always keep a source of sugar on hand.
In order not to disrupt prep for a colonoscopy, the source of sugar should be an obvious drink: “I want my patients to have clear juice, soda, or Gatorade in case their blood sugar is low.” Fixing hypoglycemia with anything else threatens to cancel the colonoscopy, which is a costly problem for everyone involved.
Low fiber diet
The first stage of colonoscopy preparation usually requires a low-fiber diet.
If you’re already eating a healthy diabetes diet — an eating pattern that avoids added sugars, refined grains and other processed foods — he’ll recommend that you eat some foods you wouldn’t normally allow yourself to do.
According to the Mayo Clinic, a low-fiber diet asks people to eat the kind of nutritionally lean foods we’re supposed to steer clear of, including white rice, pasta, low-fiber breads and crackers, and processed fruit products like juice. and apple juice and canned peaches. Meanwhile, those who are ready should have a colonoscopy no Eat healthy, whole ingredients like nuts, seeds, brown rice, quinoa, whole grain bread, beans, lentils, and most fruits and vegetables.
If you’re watching your carb and sugar intake, what are you supposed to do? For one thing, a low-fiber diet also allows the consumption of eggs, lean meats, and dairy products. You can also eat some soft, well-cooked vegetables, such as carrots or green beans. The UK’s National Health Service recommends that people with diabetes aim to get the same amount of carbohydrates they normally eat.
Some doctors also advise diabetics to tolerate high blood sugar for a day or two. A few days of suboptimal eating won’t do any long-term harm.
“A day of glucose readings that are a little higher — permissive hyperglycemia — is much better than having a severe hypo,” says Grace. “It’s just safer.”
It is probably best to discuss the details of your low-fiber eating plan with your gastroenterologist. There’s also plenty of advice on the Diabetes Daily forums, where regular people have been sharing details of their colonoscopy preparation experiences for years.
The clear liquid diet
The day before the procedure, you will likely switch to a clear liquid diet. This will allow you to eat some calories and stay hydrated without any new stool settling in your colon.
Aside from water and calorie-free beverages such as coffee or tea, the Mayo Clinic recommends some of the following foods: clear gelatin (with or without sugar), bone broth and clear soups, juice without pulp, soda, sports drinks, and ice cream.
It’s virtually impossible to eat your fill on a clear liquid diet. You will eat virtually no fat, and protein sources are not easy to find. Refined and added sugars are two of the only sources of calories you’re allowed to get.
Even if you consume more sugar than usual, you can expect to feel hungry. If you’re not excited about crash dieting for a day, ask your doctor about high-protein gelatin and pure protein shakes — they may be able to recommend a product that works for you.
It can be smart to have both sugary and sugar-free options at the ready, so you can respond to changes in your blood glucose levels.
At the same time, you may be asked to drink large amounts of laxative drinks. These solutions, like GoLYTELY, contain no calories and contain plenty of electrolytes. There are many different colonoscopy preparations and laxatives. He will be your preferred gastroenterologist and may not offer you a choice at first. But if you’re curious, Everyday Health has explored the following options: Choosing a colonoscopy setup.
The collision of diabetes medication, preparation for colonoscopy, and the procedure itself increases the risk of a variety of poor health outcomes, including hypoglycemia, lactic acidosis, and kidney injury. Working carefully with your doctor, you will have to reduce or stop taking certain medications before your colonoscopy.
The 2022 review makes some standard recommendations:
- Metformin: Stop eating when the liquid diet begins, and resume as soon as you return to eating normal meals after the procedure.
- GLP-1 receptor agonists (eg Ozempic and Trulicity): Stop eating when the liquid diet begins, and resume as soon as you return to eating normal meals after the procedure. If your regular weekly injection is scheduled during the preparation for the colonoscopy, stop until you are back to eating normally.
- DPP-4 inhibitors (eg Januvia): Stop the procedure morning and resume that evening.
- SGLT-2 inhibitors (eg Jardiance and Invokana): stop taking three days before the procedure, and resume as soon as you are back to eating normal meals And sufficiently moist.
- Sulfonylurea: Stop taking the day before the procedure and resume once you return to eating your normal meals.
Insulin, the diabetes drug most prone to hypoglycemia, and an absolute necessity for people with type 1, requires special attention. Please talk to your doctor, as the following are just starting points:
- rapid insulin: People who use the insulin-to-carbohydrate ratio to determine how quickly insulin should be used for meals can continue with the normal dosing strategy. Those using fixed doses per serving will have to lower their usual dose significantly during the clear liquid phase of the preparation.
- Basal insulin: Starting the day before the procedure, patients will be asked to decrease their basal insulin dose by 20 to 50 percent, depending on the insulin they use and the type of diabetes they have.
Grace reports that his patients using automated insulin delivery (closed-loop systems that use continuous glucose monitoring readings to automatically adjust insulin doses administered by an insulin pump) don’t need to do anything; Their system will naturally adjust to the changing insulin requirements.
Other special considerations for people with diabetes
It is important for your gastroenterologist to know that you have diabetes. Consider it your responsibility to make sure they are aware.
According to a 2022 review, diabetes is “a predictive factor for inadequate bowel cleansing,” which means that people with diabetes most likely need a second colonoscopy because their colon wasn’t clean enough for a doctor to evaluate. For example, diabetic neuropathy may slow down the digestive system, causing a standard preparation protocol to fail. If your gastroenterologist knows you have diabetes, they may recommend modifications, such as a special type of laxative or a customized diet plan.