First, I don’t know why this insists on separating Type 1 and Type 2 for discussions about diabetes issues. Is there a category for discussing such issues with everybody? I can’t find it except for things covering personal, lifestyle, art, etc. which this is not. Anyway…
I had sudden onset steroid induced diabetes, which is diagnosed as “drug induced diabetes (corticosteroids)” and also falls under the umbrella of type 2 because it’s not type 1 apparently. Anywho, I was immediately informed the pancreas as too damaged and I was insulin dependent, thus have been on Humalog and Tresiba (split dose 2X daily) for four years now, with a maintained A1c of 5.2 for the last two years (so I have more hypos than hypers on this wacky road). Also on Dexcom 6.
I have a screening colonoscopy in 4 days. Last time I had one I was not diabetic. I’ve not had any surgeries since being diabetic. The GI instructed me to hold my Tresiba the day before the procedure. As far as diet she gave me the standard colonoscopy prep of soft diet two days before prep day and liquid diet on prep day before procedure.
Thinking there might be more information about diabetic diet for colonoscopy prep I looked online through diabetes resources, GI resources, and NIH. Where I was surprised none of them said to “hold Tresiba the day before procedure.” They all had variations of reduction in dose from 20%-70%, with the majority at 50% reduction, and some had reduce by 2/3. Most said guidelines should be deferred to PCP of diabetes. So I messaged my PCP and she said,”They don’t want you’re blood sugar too high. Do as the GI instructs. Not doing so could make it so they have to cancel your procedure.”
That didn’t make sense to me. I messaged back again. She replied again to follow the GI’s instructions. Therefore, I’m apparently holding my Tresiba the day before.
Wondering what anyone else’s experiences with Tresiba day before colonoscopy have been?
Any helpful advice or experiences with diet and blood sugar management during colonoscopy prep?
This is the typical hypoglycemia phobic attitude of some medical professionals. They are so scared of a hypo that they want patients in hyperglycemia, like 250 or above.
No basal is wrong in my opinion. Also my GI wanted me to mix Miralax with regular Gaterade. I cut it half and half with no sugar Gateade and still had to do correction blouses.
I made sure that the IV was saline and not dextrose or lactating ringer.
I agree with you about the hypo fears.
Holding it didn’t make sense to me either. And since Tresiba is long acting you’d think if they were worried about hypo during prep day they would have you lower or hold it the night or day before prep day anyway. Anyway, just didn’t make sense to me.
Thanks for the tip about gatorade. My prep doesn’t call for the Miralax with Gatorade, but that’s a good tip.
Oh, plain saline in the ringer! Yes. I would never have thought of questioning that! Thumbs up! Thanks!
I talked to the doctor and they said if I needed sugar I could drink a transparent liquid just nothing red/orange and only if needed to. I didn’t end up needing anything.
I took my Tresiba and didn’t have any low issues. During the prep day I had yellow gatoraid/water 50/50. I took insulin for the carbs but allowed my blood sugar be 30ish points higher then normal that day.
Bonus: because I was diabetic they rescheduled me for 7am instead of 1pm which is the first benefit I think I’ve had from being a diabetic.
Bg is a very individual thing so I can’t tell you what to do for that for a colonoscopy. I would say no basal is too extreme maybe. as a type 1 no basal for me means dka so it would not even be an option.
I had one colonoscopy and as pwd. I recommend eating a liquid diet for at least one day before your prep to help clear yourself out. It was a nightmare for me the prep. still pooping when I arrived at the place, ugh!
I can’t remember what I did for insulin now, I had to correct or increase basal with temp rate once and then some juice or glucose tabs at some point when low after the fast but that was ok. I think I just stayed as I was then and monitored it and had my pump on regular basal for the procedure etc. which is very short, had propofol for the sedation which was FANTASTIC! Some gas and pain after were minimal.
The prep was in chamomile tea for me, no sugar. awful awful nightmarish prep, but at least the procedure was pretty easy, lol after they knocked me out at least.
Thanks for your input. I held my Tresiba for Prep day as instructed. As I suspected I think my blood sugar levels were still influenced by the previous day’s Tresiba doses, as it is after all a long-acting insulin. The only carbs I had on prep day turned out to be the 15 carbs for each of four hypos I had that day. I was so full of water from the prep 64oz plus 64 oz (taken in morning and evening) with some sugar free pedialyte sipped in between a few times, that I could not fit any other fluid in my gut! In fact my stomach rejected one of the 16oz doses of water that evening. Yuck!
I had one spike up to 183 so corrected that and was fine for several hours afterwards. The next morning at check in for procedure blood glucose was at 113, just 30-40 above usual morning level. I didn’t feel like eating much the rest of the day and had four more lows, but none of them severe the day before or the day of. So I guess it worked out fine in that regard.
I found having pre-made myself pineapple jello in 1/2 C servings was a nice change when I needed to treat a low on prep day. Sort of felt like I was eating something, but counts as clear liquid, and acts as fast carb.
The schedule the GI set for the split dose prep would have been impossible. They knew I had to drive 2 hrs to the hospital and yet they wrote that I should start the second dose of the prep at 5am. It takes 3 hrs to complete the three steps of the prep and your bowel and bladder is actively voiding starting an hour after starting and much after that three hour window of completion of the prep. My check-in time was 8:45am. No clue how they figured I would do prep while on the road and finish up while there at the hospital with no bathroom except down the hall. Now THAT is some kind of sadistic crazy, if you ask me! The math and science do not work!
I ended up doing the first half starting 9am the day before, and started the second dose at 9pm the day before. I ended up getting to bed at 2:30am and was up at 4:30 am to be on the road at 6:45am. And doc said colon was totally cleaned out.
I held Tresiba the day before as instructed. Started it back just two hrs after procedure. My blood sugar was low several times the day before and day of, but nothing severe. It spiked once the day before, again not too severe. So that all went ok. Honestly, don’t know that skipping that day made any difference, as it’s really not unusual for me to have daily mild lows. Could it have been more if I did take my Tresiba that day? Perhaps so.
Agree with you about the propofol nap! The first time I was wide awake. This was way better!
Yes. Aware many type 2 are not on insulin or oral medication. But where does that leave those of us who aren’t technically Type 2 or Type 1, are insulin dependent since day one diagnosis, but have to select Type 2 because we’re not Type 1? And then what if the topic is relevant to any of these types who happen to be on insulin? What if the topic is relevant to any of these types whether they are on insulin or not? See what I mean? That’s what I was trying to find for a category. Anyway, don’t know if that made sense or not. But there it is. My thoughts.
