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.
Two days before your test please follow a low residue diet, which 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 |
Bread White bread/toast |
| Cereals Crisped Rice cereal Cornflakes (no bran) |
Sugar/sweetener White sugar, brown sugar, sweetener |
| Cheese Cream, cottage or cheese sauce |
Dessert Clear Jelly (no red coloured Jelly) |
| Potatoes Boiled, creamed, mashed or baked (no skins) |
Pasta Plain macaroni, spaghetti Noodles |
| Rice Plain boiled white rice |
IMPORTANT: PLEASE DO NOT HAVE ANY FRUIT, VEGETABLES OR FOODS CONTAINING FIBRE
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.
The Day Before And Day Of Your Procedure
Using the table above, decide when you plan to go to bed and choose the appropriate time to stop eating any solid foods.
How to prepare and take each sachet of Klean-Prep:
• Fill a jug with 1 litre (1 3/4 pints) of water.
• Empty into the jug one sachet of Klean -Prep.
• Stir until the solution is dissolved and clear.
• Drink 1 glassful (¼ litre or ½ pint) of Klean-Prep about every 15 minutes until you have drunk it all.
• Take your time, there is no need to rush.
• You can add a clear flavour to the mixture (not red coloured) eg: lime cordial.
Recommend for a morning appointment:
You need to stop eating by 1pm the day before your appointment and start drinking your 1st sachet at 3pm, your 2nd sachet at 4pm, have a rest and start drinking your 3rd sachet at 6pm and the 4th sachet at 7pm. Please take all 4 sachets. If your colonoscopy appointment is in the morning and you are taking any oral medication in the evening, please take at least one hour after taking last sachet of Klean-Prep.
Recommend for an afternoon appointment:
You need to stop eating by 4pm the day before your appointment and start drinking your 1st sachet at 6pm, your 2nd sachet at 7pm. On the day of your procedure start drinking your 3rd sachet at 8am and your 4th sachet at 9am. Please take all 4 sachets.
If your colonoscopy appointment is in the afternoon and you are taking any oral medication in the evening, please take at least one hour after taking your 2nd sachet of Klean-Prep. On the day of the procedure, if you are taking any oral medication in the morning, please take at least one hour before taking the 3rd sachet of KleanPrep. (Patients on hypoglycaemic tablets please follow specific instructions to Diabetic Patients).
Clear Fluids - When you begin taking your preparation you should take clear fluids or jelly only. These include clear soups, consommé, stock or Bovril drinks, tea or coffee without milk, water, 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 Klean-Prep. As it cleans the gut it will make you start to produce watery bowel movements like diarrhoea. If you have not had a bowel movement after taking 2 sachets of Klean-Prep, wait until you go to the toilet before you continue.
If you have slept all night and still not had any bowel movements, please contact the Bowel Cancer Screening Department on 01253 953014 / 952855 for advice, if out of hours seek medical advice.
Nausea, vomiting, bloating and stomach cramps are common side effects. If you experience any of these try taking Klean-Prep more slowly. Rarely people are allergic to Klean-Prep 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 Klean-Prep 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 and those taking non-insulin injectable therapies and/ or oral anti-diabetics an early afternoon appointment.
NB: 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. You may on the days leading up to your Colonoscopy be at risk of having a “hypo” (too low blood sugar).
Patients who are at risk of a potential low blood glucose 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. On the day before the test when solid food must be stopped, and clear fluids only to be taken, you should take sweet drinks every 2-3 hours during the day to avoid this problem.
We aim not to admit patients during the 2 day preparation period before Colonoscopy unless their diabetes is particularly unstable, and we hope the enclosed directions are helpful.
Two days before your procedure please take the low residue diet.
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 prudent to carry out pre-meal blood glucose monitoring while carrying out the 2 day bowel preparation. Page 6 If you have any concerns about managing your diabetes while preparing for this investigation, please contact the Diabetes Specialist Nurses:
• Patients within Greater Preston contact Preston (01772) 777621 or Chorley and South Ribble contact Chorley (01257) 245350 Monday-Friday 9am till 5pm.
• For Patients within West Lancashire contact Ormskirk 0300 2470011 (option 5).
• For patients within Blackpool Fylde and Wyre area, please contact 01253 953486 Monday – Friday 09:00am – 11:00am.
• For patients within East Lancashire and Blackburn with Darwen, please contact 01254 735015.
The Day Before Your Procedure
You will have had a low residue breakfast and lunch. 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. Sugar-containing drinks may be important to keeping 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.
Medication – Oral Diabetes Tablets
Following administration of first Klean-Prep sachet no more of the following diabetes oral medications should be taken for the rest of the day:
• Glibenclamide
• Gliclazide or Glicazide MR
• Glimepiride • Glipizide
• Gliquidone • Repaglinide
• Tolbutamide • Pioglitazone
• Acarbose • Metformin
• Sitagliptin • Sitagliptin with metformin
• Vildagliptin • Vildagliptin with metformin
• Saxagliptin • Saxagliptin with Metformin
• Linagliptin
• Linagliptin with metformin
• Alogliptin • Alogpitin with Metformin
• Canagliflozin
• Canagliflozin with metformin
• Dapagliflozin
• Dapagliflozin with metformin
• Empagliflozin
• Empagliflozin with metformin
• Ertugliflozin
• Rybelsus
Non-insulin Injectable Medications:
• Exenatide (Byetta) twice daily
• Liraglutide (Victozia) once daily
• Lixisenatide (Lyxumia) once daily
Note: Once weekly preparations should be continued for example, Albiglutide, Dulaglutide and Exenatide modified release (Bydureon), Trulicity and Ozempic.
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, or if you feel unwell, or if you feel hypo. If your blood glucose goes below 4mmol/L, take 20grams carbs = 220mls glass of Lucozade or normal coke or lemonade or six glucose tablets immediately. Hypoglycaemia: The main symptoms of hypoglycaemia could be feeling sweaty, shaky, hungry, tired, dizzy, tingling on lips or anxiety/ palpitations.
Hypoglycaemia:
a blood glucose below 4mmols should be treated with 20g carbohydrate, e.g., six glucose tablets, 220ml glass of lemonade or coke or Lucozade. This should be repeated if the symptoms are not resolving, or the blood glucose is not rising after 15 minutes.
The Day Of Your Procedure:
Due to the risk of a hypo-glycaemic episode (too low blood sugar), it is important that you do not drive yourself to and from the procedure if your blood sugar is below 5.0mmols/L Test your blood glucose in the morning (if you normally do so).
If below 4mmol/L, take 20g carbohydrate, e.g take six Glucose tablets or 220ml glass of lemonade or coke (not low sugar), or Lucozade. Check blood glucose 15 minutes later and if below 4mmols repeat taking the; glucose tablets, full sugar lemonade or coke. Do not take morning diabetes medications (as listed above) and breakfast.
Clear fluids to be taken only, up to two hours of appointment. 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
Take your normal diabetes medications with meal or when next due after investigation, except SGLT2 inhibitors (for example, dapagliflozin, empagliflozin, canagliflozin). When you are feeling well and are eating and drinking normally you can restart SGLT2 inhibitors. Check your blood glucose before meals for the rest of the day if you normally self-test at home.
If you are confident about adjusting your insulin dose according to your reduced carbohydrate intake, and also substituting carbohydrate in clear liquid form (for example, lemonade, coke, Lucozade), you are advised that frequent intake of small amounts (1/4 - ½ a glass) is required.
The Day Before Your Procedure
It is important you follow the instructions from the Klean-Prep booklet.
You will have had a low residue breakfast and lunch. You must then drink only clear jelly and clear fluids such as glucose drinks, Bovril, clear soup, black tea or coffee (no milk), fizzy lemonade, coke or water. Sugar-containing drinks may be important to keeping 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. Test your blood glucose levels before administering insulin and more frequently if required.
The Day Before Your Procedure:
If you are confident in adjusting your own insulin please follow the following advice: Basal Bolus Regimens If you are taking Basal bolus regimens: do not take the short acting insulin (e.g., Novorapid, Humalog, Apidra, Fiasp) during the fasting period.
Take 80% of usual basal insulin dose (Basal insulin needs to act over a relatively long period of time and therefore basal insulin will either be long acting insulin or intermediate insulin for example Levemir, Lantus, Toujeo, Abasaglar). Long-Acting Insulin Only Or Mixed Insulin Regimes If you are taking a long-acting insulin only regime (for example, Lantus, Levemir, Insulatard, Toujeo, Tresiba) or a mixed insulin regime (for example, Humulin M3, Humalog mix 25, Insuman comb 25, Novomix 30 including other similar medications) take HALF the usual dose the day before procedure and during the fasting period.
If you are taking Hypurin / Porcine type, you are advised to contact your Diabetes Specialist Nurse.
The Day Of Your Procedure:
Morning long-acting insulin: take half the normal dose if taking a long-acting-only regime (for example, Lantus, Levemir, Abasaglar, Tresiba, Toujeo, Humulin I, Insulatard; or Insuman Basal). Patients on a basal-bolus regimen should take 80% of their usual dose.
Morning mixed insulin: take half normal dose (for example Humulin M3, Humalog mix 25, Insuman comb 25, Novomix 30 for example). Page 13 Morning short acting insulin: do not take your morning dose of, Novorapid, Humalog, Apidra, Fiasp.
Please contact your Diabetes Nurse Specialist if you are taking Hypurin Porcine type insulin. Please test your blood sugar when you get up (if you normally do so).
If below 4mmol, take 20g carbohydrate, e.g., six Glucose tablets or 220mls glass of lemonade or coke (not low sugar), or a 220mls glass of Lucozade. Check blood glucose 15 minutes later and if below 4mmols repeat taking the; glucose tablets, full sugar lemonade or coke. Please take clear fluids up to two hours of appointment.
Please take along your morning insulin and some food to the appointment, so your insulin can be given with some food after the investigation. Please do not to drive to or from your appointment if on insulin.
Please remind staff that you have diabetes on arrival to the Endoscopy Unit.
If the District Nurse administers insulin in the morning, please bring along your Folder (Yellow), insulin and syringe to the appointment.
After your Procedure:
Check your blood glucose before meals for the rest of the day if you normally self-test at home. Resume insulin at normal times and doses across the rest of the day with your normal diet.
If you have any concerns about managing your diabetes while preparing for this investigation please contact the Diabetes Specialist Nurses:
• Patients within Greater Preston contact Preston (01772) 777621 or Chorley and South Ribble contact Chorley (01257) 245350 Monday-Friday 9am till 5pm.
• For Patients within West Lancashire contact Ormskirk 0300 2470011 (option 5).
• For patients within Blackpool and Fylde and Wyre area, please contact 01253 953486 Monday – Friday 09:00am – 11:00am.
• For patients within East Lancashire and Blackburn with Darwen, please contact 01254 735015.
Blood Glucose Testing: Blood glucose testing should be done at least two – four hourly so that you can prevent hypoglycaemia by taking extra carbohydrate in the form of clear fluids if required. If your blood glucose goes below 4mmol/L, take 220mls glass of Lucozade or normal coke or lemonade or six glucose tablets immediately.
Hypoglycaemia: Hypoglycaemia should be treated with six glucose tablets, 220mls glass of lemonade or coke or 220mls glass of Lucozade. This should be repeated if the symptoms are not resolving, or the blood glucose is not rising after 15 minutes.
