Hi Folks:
Sorry I've been off line for awhile...it was TAXES, FAFSA, and DCE BUDGET TIME all in alignment!  So now that they are done, it's back to worrying about my patients. 

I've got a client that received directions from the GI MD re: his medication and food plan in preparation for a colonoscopy.  So, here's what's been suggested:

MON: Take 1/2 your insulin the day you start to prepare.  Drink your cocktail (magcitrate) at night.
TUES: drink clear liquids all day; no directions re: if they should be with or without carbs.
WED: take no insulin in the day of the test (which is first thing in the morning) BRING your insulin with you.

This gent also deals with anxiety disorder which he's treated with medication.

Pt is concerned as he's not sure which insulin he should be stopping and which insulin he should take half the dose.   He's taking lantus and humalog pre-meals-sliding scale (we had just started teaching carb counting with C:I ratio and correction dose.  He's not there yet.....

It's been awhile, so I want clarification of his plan.

I told him: call the MD, confirm it's 1/2 the lantus, verify if he can be using CARB v. no CARB foods.  I recall sick day guidelines are: every hour use fluids, but intersperse them with carb containing the first hour, and no carbs the second hour; check more frequently, and use correction doses as needed.  

Do I have it right?  Aren't there some 'new' liguid foods that have no residue that he'd be able to have?  Given the MD had sent him what was acceptable, it's all CARB, except for broth and tea! 

Does anyone have a handout for sickday guidelines food recommendations?
 

Here's what we recommend for folks in our clinic:

1. For people with Type 2 Diabetes:

A.  Ask your diabetes care provider what to do with your diabetes medications (some 

     medications may need to be adjusted or held temporarily).

B.  During the bowel prep if your blood sugar is normal (below 130) then take fluids with 

     carbohydrates in them. If your blood sugar is high (above 130), then take fluids that 

     do not contain carbohydrates - such as water.

2. For people with Type 1 Diabetes: Drink fluids which contain carbohydrates to prevent   

    DKA (Diabetic Ketoacidoses). Do not cover for these carbohydrates on the day of the 

    prep and do blood sugar corrections on the day of the prep and the colonoscopy only 

    if your blood sugar is above 150mg/dl.

A. If you are on an insulin pump:  We recommend that you keep your pump on during the 

    colonoscopy prep and the day of the procedure.  Continue your usual basal rates the 

    entire time.

                 Remind the staff that you are on an insulin pump.  Do not expose your pump to X-rays.

            B.  If you are on insulin shots: ask your diabetes care provider what to do with the doses     

                 (they will probably need to be reduced). You will still need at least a small dose of long 

                 acting insulin.

      3. For ALL individual with diabetes (any type): call your diabetes provider if you have any 

          questions or problems with your blood sugar running too high or too low.

We usually recommend 45-60 grams of carbohydrate from fluids every 2-4 hours, approximating meal times. Of course, this is adjusted based on blood sugar levels. I'm interested in hearing what other practices recommend.

Lynn: your recommendations make sense.  So here's were the health care system is so messed up...the left hand (endo) doesn't know what the right hand (GI) is doing...and the patient's feel like they are stuck in the middle!

thanks for your recommendations...have you used the new ISOPURE as a meal replacement?

You're right Joan that often health care providers aren't good at communicating with each other, and often with our patients. I'm aware of Isopure, but haven't used it. I'd love to hear from someone with experience with this product.

For what this is worth,  I checked out with our GI guru if grape flavored Iso-Pure can be used in the colonoscopy prep since each 8 ounces = 15 grams protein & 33 grams carb totaling 190 calories.   Answer:  yes.    You can go to www.isopureplus.com for more information. I think the stuff is great,  but they cannot consume the alpine punch flavor since red/orange liquids are not allowed on a colonoscopy prep diet.   This product also comes carb free (60 calories,  15 grams protein, zero carbs),  but I like the version with carbs.
 
Janet Starkey, RD, CDE

This is such great information.  I've seen the product, even tasted it...so I'll be sure to save the info and share with my client.  Do you find that you would need to have this approved with the GI MD's? 

Thanks for the feedback Janet. Outside of colonoscopy prep, are there other situations where you recommend Isopure?

Thanks for the website. Janet. I just went to it, and received a $2.00 coupon to try it.