This document provides guidelines for preparation prior to, during and following investigative procedures. Individual patients and individual circumstances may vary.
| SBAR |
Preparation Prior to Procedure |
| Situation and Background |
Preparation prior to an investigative procedure will affect normal routine and alteration of eating pattern can adversely affect the management of diabetes.
The management of diabetes medicines and insulin should be reviewed and adjusted if necessary to prevent hypoglycaemia, problems associated with hyperglycaemia, insulin omission and inappropriate use of intravenous insulin. |
| Assessment |
Consider relevant aspects of patient history/preparation which will influence management e.g.
- Type of diabetes and treatment regimen
- Ability to self manage
- Age and stage in life
- Bowel preparation prior to procedure, anti coagulation management
- Diabetes medication
- Fasting requirement
- Cardiovascular complications
- Renal function
- Recent glycaemic control (home monitoring / HbA1c)
|
| Recommendation |
Follow diabetes treatment advice provided
1.Basic Guideline for management of insulin for short fast, minor surgery
2. Basic guideline for management of non insulin medication for short fast/minor surgery
- Refer to the Diabetes Team for advice if necessary
- IV insulin is not necessary for short procedures if a rapid recovery is expected and the patient is expected to eat following the procedure
- Consider hospital admission for frail/elderly and/or identified ‘at risk’ patients
- Review and alter medication proactively if necessary to prevent problems with hypo/hyperglycaemia before, during and following procedure
- Monitor blood glucose levels appropriately to assess glycaemic control peri procedure
- Ensure appropriate treatment for hypoglycaemia is available
- Ensure prevention and management of hypoglycaemia is discussed with patients (and carers) prior to procedure
- Avoid insulin omission thereby reducing risk of diabetic ketoacidosis
- For patients who are prescribed Metformin see Radiological Procedures with Iodine Containing Contrast Exclude a contraindication (e.g. pancreatitis) before restarting a GLP-1 analogue (Liraglutide / Lixisenatide /Exenatide)
Contact details for Diabetes Team
- Diabetes Specialist Nurses (Office hours Monday – Friday)
- Ninewells Hospital - 01382 660111 ext. 32293/36009
- Perth Royal Infirmary - 01382 660111 ext. 13476
- Abbey Health Centre, Arbroath - 01241 447811
- Diabetes Specialist Registrar - Page 5416
|
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ULTRASOUND SCANS
No special preparation required for pelvic ultrasound scan bladder, renal, uterus, and prostate
Upper and lower abdominal ultrasound
General information
- Four hour fast prior to procedure
- Fat free diet, no milk
- Avoid gassy food and drinks on evening before, and day of examination
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required.
Basic Guideline for management of insulin for short fast, minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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C.T. SCANS
Chest, head and neck
No special dietary preparation
Abdomen and Pelvis
General information
- Four hour food and fluid fast prior to procedure
- Avoid gassy food and drink on day before and, day of examination e.g. Green vegetables/salads, fresh fruit, beans, fatty foods and fizzy drinks.
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
- Continue all other tablets as usual until day of test
Diabetes treated with tablets
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin or insulin with Metformin
- If CT involves contrast, see Radiological Procedures with Iodine Containing Contrast Follow guidelines on restarting Metformin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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BARIUM SWALLOW / MEAL
General information
- Nil by mouth from 22.00hours on evening prior to procedure
- Early morning appointment desirable (9.00 hrs)
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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BARIUM ENEMA
General Information
- No solid food from 08 00 hours on the day prior to procedure
- Bowel preparation as per instruction from radiology
- The success of the procedure depends on the bowel being as clear as possible
- Picolax instructions recommend a low residue diet with water/clear fluids 250mL hourly throughout the treatment with picolax until bowel movements have ceased
- It is essential that people prescribed oral hypoglycaemic agents and insulin have regular carbohydrate intake.
- The following fluids contain 10 grams CHO: 100mL fruit juice, 50mL lucozade, 150mL coca cola/lemonade (not diet) and 2 tablespoons jelly (ordinary).
- NB no fizzy drinks allowed, therefore allow lucozade, cola and lemonade to ‘go flat’ prior to consumption
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
- Early morning appointment desirable
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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BARIUM FOLLOW THROUGH / SMALL BOWEL ENEMA
General Information
- Early morning appointment desirable
- Food and fluid fast from 22.00 hours on evening prior to procedure
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure blood glucose monitoring is undertaken and appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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GASTROSCOPY
General Information
- Six hour food fast prior to procedure
- Two hour fluid fast prior to procedure
- 9.00 hr appointment desirable
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
- Assessment of swallow following procedure before resuming food required
- If swallow reflex has not returned in two hours post procedure intravenous insulin infusion should be commenced in people normally treated with tablets and / or insulin
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal 'breakfast' insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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OESOPHAGEAL BANDING
General information
- Six hour food and fast prior to procedure
- Two hour fluid fast prior to procedure
- 9.00 hr appointment desirable
- Chest x-ray required after procedure
- Chest x-ray required prior to resuming diet and fluids
- If the patient is expected to miss two meals post procedure or is unable to tolerate oral intake intravenous (IV) insulin may be required
- If food and fluid intake is delayed two hours post procedure IV insulin infusion should be commended in people normally treated with tablets and insulin (see page 28)
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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OESOPHAGEAL DILATATION
General information
- Six hour food and fast prior to procedure
- Two hour fluid fast prior to procedure
- 00 hr appointment desirable
- Chest x-ray required after procedure
- Chest x-ray required prior to resuming diet and fluids
- If the patient is expected to miss two meals post procedure or is unable to tolerate oral intake intravenous (IV) insulin may be required
- If food and fluid intake is delayed two hours post procedure IV insulin infusion should be commended in people normally treated with tablets and insulin (see page 28)
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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CORONARY ANGIOGRAM /CATHETERISATION
General information
- Food fast for two hours prior to procedure
- Free fluids allowed
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin or insulin with metformin
- If CT involves contrast, see Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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TRANSOESOPHAGEAL ECHOCARDIOGRAM
General information
- Food and fluid fast for 6 hours prior to procedure
- 2 hours fast post procedure
- Assessment of swallow following procedure before resuming food
- If swallow reflex has not returned in two hours post procedure GKI infusion should be commenced in people normally treated with tablets and/or insulin
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
Back to the top of this page
DC CARDIOVERSION
General information
- Six hour food and fluid fast prior to procedure
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
Back to the top of this page
BRONCHOSCOPY/LUNG BIOPSY
General information
- Four hour food fast
- Water allowed until two hours prior to procedure
- Assessment of swallow following procedure before resuming food
- If swallow reflex has not returned in two hours post procedure G.K.I infusion should be commenced in people normally treated with tablets and/or insulin
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
Back to the top of this page
RENAL ANGIOGRAM
General information
- Four hour food fast,
- Water allowed until two hours prior to procedure
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
- If patient is prescribed Metformin, see Radiological Procedures with Iodine Containing Contrast
VENOGRAM
PERIPHERAL ANGIOGRAM
Diabetes treated with tablets
INTRAVENOUS UROGRAM
General information
- Four hour fast prior to procedure
- Free fluids allowed to maintain hydration
- Avoid gassy food and drink prior to appointment
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin or insulin with Metformin
- If CT involves contrast, see Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
Back to the top of this page
LIVER BIOPSY
General information
- Four hour food fast
- Water allowed until two hours prior to procedure
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
SIGMOIDOSCOPY
General Information
- Follow diet and bowel preparation as per instruction from Endoscopy department
- On the day before procedure
- Light breakfast and lunch on day prior to procedure followed by fluid diet
- The success of the procedure depends on the bowel being as clear as possible.
- Picolax instructions recommend a low residue diet with water/clear fluids 250mL hourly throughout the treatment with picolax until bowel movements have ceased
- Fluid diet includes black tea or coffee, lemonade, water, strained soup, jelly
- Avoid fluids with artificial colours especially red or blackcurrant juices/tomato soup
- It is essential that people prescribed oral hypoglycaemic agents and insulin have regular carbohydrate intake
- The following fluids contain 10grams CHO: 100mL fruit juice, 50mL lucozade, 150mL coca cola/lemonade (not diet), and 2 tablespoons jelly (ordinary)
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
- 9.00 hr appointment desirable on day of procedure
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
COLONOSCOPY
General information
- Follow diet and bowel preparation as per instruction from Endoscopy department
- On the day prior to procedure
- Normal breakfast on day prior to procedure followed by fluid diet
- The success of the procedure depends on the bowel being as clear as possible.
- Picolax instructions recommend a low residue diet with water/clear fluids 250mL hourly throughout the treatment with picolax until bowel movements have ceased
- Fluid diet includes: black tea or coffee, lemonade, water, strained soup, jelly.
- Avoid fluids with artificial colours especially red or blackcurrant juices/tomato soup
- It is essential that people prescribed oral hypoglycaemic agents and insulin have regular carbohydrate intake.
- The following fluids contain 10grams CHO: 100mL fruit juice, 50mL lucozade, 150mL coca cola/lemonade (not diet), and 2 tablespoons jelly (ordinary)
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
- 9.00 hr appointment desirable on day of procedure
- Six hour food fast prior to procedure
- Two hour fluid fast prior to procedure
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
ERCP (ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY
General information
- IV insulin is not necessary if a rapid recovery is expected and the patient is expected to eat following the procedure
- Six hour food and fast prior to procedure
- Two hour fluid fast prior to procedure
- Assessment of swallow following procedure before resuming food
- 9.00 hr appointment desirable If food and fluid intake is delayed two hours post procedure GKI infusion should be commenced in people normally treated with tablets and/or insulin
- Prevent hypoglycaemia in people prescribed oral hypoglycaemic agents and insulin
- Monitor blood glucose
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
INTRAVENOUS CHOLANGIOGRAM
General information
- Avoid gassy foods prior to fast
- Gassy foods include green vegetables/salads, fresh food, beans, fizzy drinks
- Four hour fast prior to procedure
- Free fluids (no milk) allowed to maintain hydration
- Prevent hypoglycaemia in people prescribed oral hypoglycaemic agents and insulin
- Monitor blood glucose and ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin or insulin with Metformin
- If CT involves contrast, see Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
MODIFIED SHORT SYNACTHEN TEST
General information
- Four hour food fast prior to procedure (ideally)
- Free fluids (avoiding milk) allowed
- 9.00 hr appointment desirable
- Prevent hypoglycaemia in people prescribed oral hypoglycaemic agents and insulin
- Monitor blood glucose and ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
- Take usual diabetes tablets with food before fast
- Resume diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue Exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
GLOMERURAL FILTRATION RATE
General information
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
GASTRIC EMPTYING TESTS
General information
- Nil by mouth from midnight before the procedure
- Early morning appointment desirable
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Ensure blood glucose monitoring is undertaken and appropriate treatments for hypoglycaemia are available
In people treated with insulin, consider Intravenous insulin if first am appointment cannot be given
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue, exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
GALL BLADDER STUDIES
General Information
- Nil by mouth from midnight before the procedure
- Early morning appointment desirable
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Ensure blood glucose monitoring is undertaken and appropriate treatments for hypoglycaemia are available
In people treated with insulin, consider Intravenous insulin if first am appointment cannot be given
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue, exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
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GLYCHOLIC BREATH TESTS
General Information
- Nil by mouth from midnight before the procedure
- Early morning appointment desirable
- Oral hypoglycaemic agents and/or insulin can cause hypoglycaemia
- Ensure blood glucose monitoring is undertaken and appropriate treatments for hypoglycaemia are available
In people treated with insulin, consider Intravenous insulin if first am appointment cannot be given
Diabetes treated with tablets
- Take diabetes medication with food as prescribed before fast.
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue, exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Resume normal insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Seek advice from the Diabetes Team if required
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
COMPUTERISED TOMOGRAPHY- POSITRON EMISSION TOMOGRAPHY (CT-PET) STUDIES
General Information
- Fast from midnight
- Aim for first scan on the morning list
- Check HbA1C ( if not done within prior 2 months)
- Consider overnight admission for intravenous insulin or referral to the diabetes team to intensify therapy if HbA1c is 75 or more
- Check finger prick glucose before the procedure.
- Do not proceed if blood sugar is greater than 10mmol/
- lPatients who are elderly, infirm or have chronically poor control should be considered for overnight admission to CIU
- If patient is eating normally by lunchtime, intravenous insulin is usually not necessy
- Monitor blood glucose and ensure appropriate treatments for hypoglycaemia are readily available.
- Omit morning diabetes tablets
- Recommence diabetes medication with food following the testyPrevent hypoglycaemia in people prescribed oral hypoglycaemic agents and insulin
In people treated with insulin, consider Intravenous insulin if first am appointment cannot be given
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I
- Omit breakfast insulin prior to procedure (except basal insulin)
- Resume usual insulin as prescribed with food after the procedure
- In people prescribed twice daily insulin regimens, prescribe half of the normal ‘breakfast’ insulin dose with lunch after (morning) procedure
Diabetes treated with tablets
- If patients prescribed metformin see radiological procedures with iodine containing contrast
- Take diabetes medication with food as prescribed before fast.
- Follow guidelines on restarting Metformin
- Resume usual diabetes medication as prescribed with food following procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (e.g. Exenatide/ Liraglutide/Lixisenatide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Before restarting GLP-1 analogue, exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose (30 – 50%) prior to fast to reduce risk of hypoglycaemia
- Resume normal insulin as prescribed with food following procedure
Seek advice from the Diabetes Team if required
Basic Guideline for management of insulin for short fast, minor surgery
Basic guideline for management of non insulin medication for short fast/minor surgery
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MANAGEMENT OF PATIENTS WITH DIABETES UNDERGOING DAY CASE SURGERY
General information
- Fast from midnight
- Aim for surgery on morning list
- Check a finger prick glucose before and after the procedure
- Elderly or infirm or patients with unstable control may require admission on previous day and will require a G.K.I. infusion
- If rapid recovery expected and patient to be eating normally by lunchtime, intravenous insulin infusion is not necessary
- If patient is unable to tolerate diet and/or blood glucose is > 14 mmol/L commence G.K.I. infusion
- Prevent hypoglycaemia in people prescribed oral hypoglycaemic agents and insulin
- Monitor blood glucose and ensure appropriate treatments for hypoglycaemia are available.
Diabetes treated with tablets
Diabetes treated with insulin or insulin with metformin
- Fast from midnight
- Continue basal (long acting) insulin as prescribed for people with type 1 diabetes. Basal insulin preparations include Lantus, Levemir, Insulatard & Humulin I given on the evening prior to surgery
- Omit morning insulin (except basal insulin)
- Resume normal insulin with food following procedure
- See Radiological procedures with iodine containing contrast
- If BD insulin regimen is restarted at lunchtime it is recommended that half of the normal ‘breakfast’ insulin dose should be prescribed with lunch after procedure
Diabetes treated with GLP-analogues
- GLP-1 analogues (Exenatide / Liraglutide) slow gastric emptying
- Omit GLP-1 analogue during bowel preparation
- Omit GLP-1 analogue on day of procedure
- Exclude any contraindication before restarting GLP-1 analogue after procedure e.g. pancreatitis or active bowel disease
- Seek advice from the Diabetes Team
For further information on Diabetes and Surgery, see Handbook Section on Perioperative Guidelines
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GLUCOSE - POTASSIUM-INSULIN INFUSIONS – G.K.I.
Guideline for G.K.I. infusion for patients who have to fast for a procedure
- Check U&E’s
- Check finger prick blood glucose (BG)
- Add short acting insulin (e.g. Actrapid or Humulin S) to a 500 ml bag of 10% Dextrose + 10 mmol/l KCL. The amount of insulin added is determined by the finger prick blood glucose (BG) recording as shown below
| BG mmol/L |
Units of Insulin |
| < 4.0 |
Seek help – Patient may require 50 ml of 50% dextrose IV prior to commencing G.K.I. |
| 4.0 - 6.9 |
10 units |
| 7.0 – 12.9 |
15 units |
| 13.0 – 17.0 |
20 units |
| > 17.0 |
Seek help – sliding scale insulin infusion may be more appropriate. |
- Omit KCL if there is significant renal impairment (eGFR < 30). You may also need to reduce the volume of fluid given as the above delivers 100 ml/hour. Contact the Diabetes team or Renal team for further advice.
- Infuse the 500 ml bag over 5 hours.
- Blood glucose (finger prick) should be checked after 1 hour and then 2 hourly thereafter and the insulin changed according to the blood glucose (finger prick) by replacing the infusion bag with a NEW bag containing the correct insulin concentration.
- K+ should be rechecked 6 hours after commencing the infusion and then daily if the infusion is to be continued.
- Some patients, e.g. very obese, those receiving high dose steroids or those with active infection, may have much higher insulin requirements – please contact the Diabetes team for advice (see below).
- Once patient is eating normally return to the patient’s usual insulin or tablet regime. Monitor finger prick blood glucose 4 hourly until blood glucose is stable (4-7 mmol/L).
Contacts: Diabetes Team
Diabetes Specialist Nurses (Office hours Monday – Friday)
Ninewells Hospital - 01382 660111 ext. 32293/36009
Perth Royal Infirmary - 01382 660111 ext. 13476
Abbey Health Centre, Arbroath - 01241 447811
Diabetes Specialist Registrar - Page 5416
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