Before your Procedure.
In order to examine the whole of the bowel it must be clear of all waste materials. This is achieved by using a combination of changing what you eat and taking laxative medicines. Please follow the instructions printed below.
7 days before your Procedure please stop taking Iron tablets.
2 days before your Procedure please stop taking any medicines which may constipate you for example, Codeine, Co-phenotrope (Lomotil), Kaolin and Morphine, Loperamide (Imodium).
All other medication should be continued as normal unless otherwise instructed by the Specialist Screening Practitioner.
Start your low residue diet on ……………………............……………
A low residue diet consists of the following:
Fats (use sparingly) Butter, Margarine
Meat/Fish Minced or well cooked, tender lean Beef, Lamb, Ham, Pork, Poultry, Fish, Shellfish.
Eggs Boiled, poached
Cereals Crisped Rice cereal Cornflakes (no bran)
Bread White bread/toast
Cheese Cream, cottage or cheese sauce
Sugar/sweetener White sugar, brown sugar sweetener
Potatoes Boiled, creamed, mashed or baked (no skins)
Dessert Clear Jelly (no red coloured Jelly)
Rice Plain boiled white rice
Pasta Plain macaroni, spaghetti Noodles
**** Important: Please Do Not Have Any Fruit, Vegetables Or Foods Containing Fibre ****
In some cases, you may be asked to follow a low residue diet
up to two weeks before the procedure. The nurse will inform
you if you are required to do this.
You may be asked to take Senokot® tablets before your
procedure. The information and instructions will be given to
you by the nurse if you are required to do this.
Please note: If you have not passed wind or opened your
bowels in the 5 days leading up to taking your bowel prep,
please contact the Specialist Screening Practitioner for advice
at the Bowel Cancer Screening Programme office on 01253
953014 / 952855 for advice.
It is important you follow the specific instructions depending on the
time of your appointment. If you are diabetic please follow the
specific diabetic instructions on pages 7-16.
Instructions for a morning appointment:
On the day before your appointment do not eat anything after 1pm because your bowel must be completely empty before your examination.
At 5pm, make up your first litre of MOVIPREP and drink it over 1-2 hours. Have a rest for 2 hours. It is important to drink an additional 500mls of clear fluids with each litre of MOVIPREP during the evening.
Between 8pm and 9pm, make up your second litre of MOVIPREP and drink it over 1-2 hours.
It is important to drink an additional 500mls of clear fluids with each litre of MOVIPREP during the evening.
Allow 2 hours for MOVIPREP to work after finishing the second litre. You can go to bed when you stop going to the toilet (for example 11pm).
Medications
Please take any oral medication (tablets) at least one hour before or one hour after you take Moviprep.
Clear Fluids
When you begin taking MOVIPREP, you should take clear fluids only. These include clear soups, consommé, stock or Bovril drinks, tea or coffee without milk, water, cordial, fizzy drinks and clear jellies (not red coloured). These can be taken up to 2 hours before your colonoscopy.
Stay Near a Toilet
You should start to have your bowels open 1-2 hours after starting to take MOVIPREP. As it cleans the gut it will make you start to produce watery bowel movements like diarrhoea. If you have If you have not had any bowel movements after taking your first sachet of MOVIPREP please contact the Bowel Cancer Screening Department on 01253 953014 / 952855 for advice, if out of hours seek medical advice.
Side Effects
Nausea, vomiting, bloating and stomach cramps are tiredness are very common side effects. If you experience any of these try taking MOVIPREP more slowly. Rarely people are allergic to MOVIPREP and may get an itchy skin rash (nettle rash or hives), swelling of your face, ankles or other part of your body, palpitations (you may notice your heart beating more) extreme fatigue, shortness of breath. If any of these symptoms occur stop taking MOVIPREP and seek immediate medical attention and inform the Bowel Cancer Screening Dept on 01253 953014 / 952855.
Instructions for an afternoon appointment:
On the day before your appointment do not eat anything after 3pm because your bowel must be completely empty before your examination.
At 7pm make up your first litre of MOVIPREP and drink it over 1-2 hours. It is important to drink an additional 500mls of clear fluids with each litre of MOVIPREP.
Allow 2 hours for MOVIPREP to work after finishing the second litre. You can go to bed when you stop going to the toilet (for example 11pm).
On the day of the appointment: Do not eat anything. At 6am make up and drink your second litre of MOVIPREP over the next 1-2 hours. It is important to drink an additional 500mls of clear fluids with each litre of MOVIPREP
Medications
Please take any oral medication (tablets) at least one hour before or one hour after you take Moviprep.
Clear Fluids
When you begin taking MOVIPREP, you should take clear fluids or jelly only. These include clear soups, consommé, stock or Bovril drinks, tea or coffee without milk, fizzy drinks (not red coloured), water and clear jellies (not red coloured). These can be taken up to 2 hours before your colonoscopy.
Stay near a toilet – You should start to have your bowels open 1-2 hours after starting to take MOVIPREP. As it cleans the gut it will make you start to produce watery bowel movements like diarrhoea. If you have not had any bowel movements after taking your first sachet of MOVIPREP please contact the Bowel Cancer Screening Department on 01253 953014 / 952855 for advice, if out of hours seek medical advice e.g.: via 111.
Side effects – Nausea, vomiting, bloating, stomach cramps and tiredness are very common side effects. If you experience any of these try taking MOVIPREP more slowly. Rarely people are allergic to MOVIPREP and may get an itchy skin rash (nettle rash or hives), swelling of your face, ankles or other part of your body, palpitations (you may notice your heart beating more), extreme fatigue, shortness of breath. If any of these symptoms occur stop taking MOVIPREP and seek immediate medical attention and inform the Bowel Cancer Screening Dept on 01253 953014 / 952855.
We do aim to give patients with insulin treated diabetes a morning appointment. Those patients who are taking non-insulin injectable therapies and/ or oral antidiabetic medications will be given at the latest an early afternoon appointment.
If you are on insulin therapy and your appointment time is not prior to 11am please contact the Bowel Cancer Screening
Department on 01253 953014 / 952855 to reschedule for an earlier appointment time.
The necessary change in your diet may upset your diabetes. However do not worry as this will not cause any long-term harm.
On the days leading up to your Colonoscopy you may be at risk of having a “hypo” (too low blood sugar).
If you are at risk of a potential low blood glucose you can prevent this by taking a small quantity of a sugar-containing drink if needed. It would be a good idea for you to monitor your blood glucose if this is likely to happen.
We aim not to admit patients during the bowel preparation period before Colonoscopy unless their diabetes is particularly unstable, and we hope the enclosed directions are helpful.
Start your low residue diet on ……………………............………
please follow the low residue diet set out on page 2 of this
leaflet.
The low residue diet can be combined with your usual diabetes medication, but you need to make sure that you have either cereal, bread, potato, pasta or rice as allowed on the low residue diet with each meal.
If you normally monitor your own blood glucose tests at home then it would be a good idea to carry out blood
glucose monitoring before meals and while taking the bowel preparation.
If you have any concerns about managing your diabetes while preparing for this investigation please contact the Diabetes Specialist Nurses below or the primary care team if they manage your diabetes care:
Patients within Greater Preston contact Preston (01772) 777621 or Chorley and South Ribble contact Chorley (01257) 245350 MondayFriday 9am to 5pm.
For Patients within West Lancashire contact Ormskirk 0300 2470011 (option 5).
For patients within Blackpool area and North Lancashire, please contact 01253 953486 Monday – Friday.
For patients within East Lancashire and Blackburn with Darwen, please contact 01254 735015.
Please follow the following appropriate instructions:
The Day before your Procedure
It is important that you follow the instructions from the booklet. If you have a morning appointment you can have a low residue breakfast and lunch as long as it is before 1pm. If you have an afternoon appointment you can have a low residue breakfast and lunch as long as it is before 3pm.
You must then drink only clear jelly, clear fluids such as glucose drinks, Bovril, clear soup, black tea, or coffee (no milk), fizzy
lemonade, coke or water. These can be taken up to two hours before the procedure.
Drinks containing sugar may be important to keep the blood glucose from dropping too low. Take these in small quantities at regular intervals across the day and evening to keep the blood glucose stable.
• Patients on oral diabetic medications will be advised to follow specific instructions according to the medication they are taking
set out in table 1 on page 11.
• Patients whose diabetes is treated with insulin injectable therapies should follow the specific instructions according to
their medication set out in table 2 pages 12 & 13.
• Patients whose diabetes is treated with GLP-1 agonist Injection should follow the specific instructions according to their
medication set out in table 3 page 15.
Blood Glucose Testing:
If you normally self-test using a blood glucose, it is advisable to check your blood glucose level regularly during the day prior to the
investigation. Check the blood glucose by testing four–six hourly, if you feel unwell, or if you feel hypoglycaemic.
Hypoglycaemia:
The main symptoms of hypoglycaemia could be feeling sweaty, shaky, hungry, tired, dizzy, tingling on lips or anxiety/ palpitations.
What to do if your blood sugar falls to 5mmol/L or less:
If your blood sugar falls to 5mmol/L or less take 15-20 grams of carbohydrate, e.g., take six Glucose tablets or 200mls of Glucose
(Lucozade®), lemonade or coke (not low sugar).
Recheck your blood glucose 15 minutes later and if below 4mmol/L repeat taking the; glucose tablets, full sugar Lucozade®, lemonade or coke.5mmol, take 20mg carbs = 220mls glass of Lucozade® or
normal coke or lemonade or six glucose tablets immediately.
Medication – Oral Diabetic Tablets (Table 1)
|
Oral diabetes medication |
Day before Procedure |
Day of Procedure |
Day after Procedure |
||
|---|---|---|---|---|---|
| Acarbose | Take as normal | Do not take | Take as normal | ||
| Metformin | Take as normal |
Take as normal if taken once or twice a day.
If taken three times a day omit lunchtime dose only. |
Take as normal | ||
| Pioglitazone | Take as normal | Take as normal | Take as normal | ||
|
DPP4 Inhibitors: Alogliptin Linagliptin Saxagliptin Sitagliptin Vildagliptin |
Take as normal | Take as normal | Take as normal | ||
|
SGLT Inhibitors: Canagliflozin Diapagliflozin Empagliflozin Ertugliflozin |
Do not take | Do not take |
Take as normal if eating and drinking normally |
||
|
Long acting: Sulfonylureas Glimepiride |
Do not take |
Take normal dose after procedure if eating and drinking normally |
Take as normal | ||
|
Sulfonylureas: Gliclazide Gliclazide MR Glipizide and Tolbutamide |
Do not take |
Ormit any morning dose. Take any evening doses if eating and drinking normally |
Take as normal. | ||
|
GLP-1 Agonist: Semaglutide (Rybelsus) |
Take as normal | Do not take | Take as normal |
Medication - Insulin Injectable therapies (Table 2)
| Injections |
Day before Procedure |
Day of Procedure |
Day after Procedure |
|---|---|---|---|
|
Quick acting Insulin: Actrapid, Apidra, Fiasp, Humalog, Humulin s, Hypurin porcine neutral, Lyumjev, Novorapid, Trurapi |
Take as normal for any meals consumed. Stop the quick acting insulin for individual missed meal(s) |
Stop any doses due before the procedure. Take as normal for any meal(s) consumed after the procedure. |
Take as Normal |
|
Long acting: Insulin taken once a day in the evening Abasaglar, Humulin I, hypurin porcine Isophane, Insulatard, Lantus, Levemir, Semglee, Toujeo, Tresiba |
Take 80% of your usual dose for 2 days before the procedure | Take usual dose in the evening |
Take as Normal |
|
Long acting: Insulin taken once a day in the morning Abasaglar, Humulin I, Hypurin porcine Isophane, Insulatard, Lantus, Levemir, Semglee, Toujeo, Tresiba |
Take 80% of your usual dose one day before the procedure | Take 80% of your usual dose | Take as normal |
Medication – insulin injectable therapies (Table 2) continued
| Injections |
Day before Procedure |
Day of Procedure |
Day after Procedure |
|---|---|---|---|
|
Long acting: Insulin taken twice a day Abasaglar, Humulin porcine, Isophane, Insulatard, Lantus, Levemir, Semglee, Toujeo, Tresiba |
Take 80% of your usual dose one day before the procedure. |
Take 80% of your usual dose on the morning of the procedure. Go back on your usual evening dose after the procedure. |
Take as normal |
|
You take long - acting insulin only once or twice per day (without quick acting insulin) |
Take 50% of your dose one day before the procedure |
Take 50% of your usual dose for any doses due before the procedure. Resume taking your usual |
Take as normal |
|
pre-mixed/ biphasic insulin twice or three times a day: humalog mix 25, humalog mix 50, Humulin m3, Hypurin porcine 30/70 mix, Novomix 30 |
Take 50% of your usual dose one day before the procedure. |
Take 50% of your usual dose for any doses due before the procedure. Resume taking your usual dose after the procedure. |
Take as normal |
Medication – GLP-1 agonist Injection (Table 3)
| Injections |
Day before Procedure |
Day of Procedure |
Day after Procedure |
|
|---|---|---|---|---|
|
If you are on daily injections of GLP-1 agonist therapy: Exenatide (Byetta), Liraglutide (Victoza) or Lixisenatide (Lyxumia) |
Take as Normal |
Exenatide (Byetta): Stop morning dose, Take evening dose as usual. Liraglutide and Lixisenatide: Take as normal |
Take as normal | |
| If you take the insulin degludec with liraglutide combination product (Once daily): Xultophy | Take 50% of your usual number of dose - steps |
Take 50% of your usual number of dose - steps, If taken in the Morning Take as normal if taken in the evening |
Take as normal | |
| Long - acting (Once weekly): Dulaglutide (Trulicity) Exenatide LAR (Bydureon), Semaglutide (Ozempic), Tirzepatide (Mounjaro) | Take usual dose at usual time | Take usual dose at usual time | Take usual dose at usual time |
The Day of the procedure:
Due to the risk of a hypoglycaemic episode (too low blood
sugar), it is important that you do not drive yourself to and
from the procedure if your blood glucose is below 5.0mmols.
Test your blood glucose in the morning (if you normally do so). and
continue to do so 2-4 hourly. If your blood sugar falls to 5mmol/L
or less take 15-20 grams of carbohydrate, e.g., take six Glucose
tablets or 200mls of Glucose (Lucozade®), lemonade or coke (not
low sugar). Recheck blood glucose 15 minutes later and if below
4mmol/L repeat taking the; glucose tablets, full sugar Lucozade®,
lemonade or coke.
Follow the specific diabetic instructions set out in tables 1, 2 and 3
on pages 10-14 according to the medication you are taking.
Clear fluids to be taken up to two hours before your colonoscopy.
Take along your diabetes medications and some food to your
appointment, so that you can have your diabetes medications with
some food after your investigation. On arrival, remind staff that you
have diabetes.
After Your Procedure
• Follow the specific diabetic instructions on pages 10-14
according to the medication you are taking which explains when
to restart your diabetic medication.
• If you are taking insulin, you will resume normal insulin dosing
with your first meal after your procedure and will resume taking
your insulin at normal times across the rest of the day with
normal diet.
• Check your blood glucose before meals for the rest of the day if
you normally self-test at home.
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Author Bowel Cancer Screening Programme
Approved by Medicine Management and Safety Review Committee
Reference No PL/1384 (v3)
Review Date 01/04/2029
