This document provides guidelines for healthcare professionals regarding preparation prior to, during and following investigative procedures. Individual patients and individual circumstances may vary, refer to the diabetes team for advice if necessary.
| SBAR |
Preparation Prior to Procedure |
| Situation and Background |
Preparation prior to an investigative procedure will affect normal routine.
Alteration of eating pattern can 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 medication/insulin treatment regimen
- Ability to self manage
- Age and stage in life
- Bowel preparation prior to procedure, anti coagulation management
- 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
- Variable Rate Intravenous Insulin Infusion (VRIII) is not necessary for short procedures if a rapid recovery is expected and the patient is expected to eat following the procedure. Link to Variable Rate Intravenous Insulin Infusion guidance
- Consider hospital admission for frail/older people
- 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
- Continuous Glucose Monitoring Systems sensors should be removed for CT and MRI scans, diathermy and x-ray procedures as exposure may damage the sensor. New CGMS sensors can be applied post procedure
- For patients who are prescribed Metformin see Radiological Procedures with Iodine Containing Contrast
- Exclude a contraindication (e.g. pancreatitis) before restarting a GLP-1RA analogue (Liraglutide / Semaglutide)
Contact details for Diabetes Team
- Diabetes Specialist Nurses (Office hours Monday – Friday)
- Ninewells Hospital - 01382 660111 ext. 36431/36009
- Perth Royal Infirmary - 01382 660111 ext. 13976
- Abbey Health Centre, Arbroath - 01241 447811
- Diabetes Specialist Registrar - Page 5416
- Email: tay.diabendoreferrals@nhs.scot
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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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure/ during bowel preparation
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin or insulin with Metformin
- See Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Consider reduction in insulin dose if recent glucose levels have been < 6mmol/L 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, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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 22.00 hours 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose if recent glucose levels have been < 6mmol/L 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, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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, 150mL coca cola/lemonade (not diet) and 2 tablespoons jelly (ordinary).
- NB no fizzy drinks allowed, therefore allow cola/ 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure/ bowel preparation
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose if recent glucose levels have been < 6mmol/L 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, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
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 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure/during bowel preparation
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose if recent glucose levels have been < 6mmol/L 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, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
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 VRIII should be commenced in people normally treated with tablets and / or insulin. Link to Variable Rate Intravenous Insulin Infusion guidance
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure/during bowel preparation
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose if recent glucose levels have been < 6mmol/L 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, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual'breakfast' insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
OESOPHAGEAL BANDING
General information
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose if recent glucose levels have been < 6mmol/L 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, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
OESOPHAGEAL DILATATION
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 VRIII 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 Link to Variable Rate Intravenous Insulin Infusion guidance
- 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose if recent glucose levels have been < 6mmol/L 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, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin or insulin with metformin
- See Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
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 VRIII should be commenced in people normally treated with tablets and/or insulin Link to Variable Rate Intravenous Insulin Infusion guidance
- 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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 VRIII should be commenced in people normally treated with tablets and/or insulin. Link to Variable Rate Intravenous Insulin Infusion guidance
- 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
- See Radiological Procedures with Iodine Containing Contrast
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
VENOGRAM
Basic guideline for management of insulin for short, fast minor surgery
Basic Guideline for management of non insulin medication for short fast / minor surgery
PERIPHERAL ANGIOGRAM
Diabetes treated with tablets
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 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
- If CT involves contrast, discontinue Metformin 48 hours before procedure - see Radiological Procedures with Iodine Containing Contrast
- Take diabetes medication as prescribed with food before fast
- Resume diabetes medication (not Metformin) as prescribed with food after procedure.
- Follow guidelines on restarting Metformin
Diabetes treated with Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin or insulin with Metformin
- See Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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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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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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, 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure/during bowel preparation
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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, 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure/during bowel preparation
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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 VRIII 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
- Ensure appropriate treatments for hypoglycaemia are available
Diabetes treated with tablets
Diabetes treated with Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
- GLP-1RA (e.g. Exenatide / Liraglutide/Lixisenatide) slow gastric emptying
Diabetes treated with insulin or insulin with Metformin
- See Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usualinsulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
- 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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying, individual assessment, can be administered post fast
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII can be continued by the patient during fast and the procedure providing the person is alert and able to self manage.
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 VRIII if first am appointment cannot be given Link to Variable Rate Intravenous Insulin Infusion guidance
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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 VRIII if first am appointment cannot be given Link to Variable Rate Intravenous Insulin Infusion guidance
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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 VRIII if first am appointment cannot be given Link to Variable Rate Intravenous Insulin Infusion guidance
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 Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Consider reduction in insulin dose prior to fast if recent glucose levels have been < 6mmol/L to reduce risk of hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Resume usual insulin as prescribed with food following procedure
- In people prescribed twice daily insulin regimens, prescribe half of the usual ‘breakfast’ insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
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
- Appropriate preparation is required prior to PET scan to achieve glucose levels <10.0mmol/L. The procedure may be rescheduled if glucose is > 10.0mmol/L
- Check HbA1C (if not done within prior 2 months)
- Refer to the diabetes team to intensify therapy if HbA1c is 75 mmol/mol or more
- Raised glucose levels can decrease radioactive tracer uptake by tumours and therefore have an adverse effect on imaging
- Insulin administration to lower glucose levels in the period before a PET scan can increase radioactive tracer uptake in cardiac and skeletal muscle adversely affecting imaging so avoid bolus short acting subcutaneous insulin injections four hours prior to PET scan
- Basal insulin can be continued in those usually prescribed multiple daily injection regimens
- Medication management review - individual assessment to take cognisance of medications that can elevate glucose e.g. corticosteroid, lithium, tricyclic antidepressants, phenytoin, thiazide diuretics
- Metformin can adversely affect imaging
- Patients who are older, frail or who have chronically suboptimal glycaemic control can be considered for overnight admission to CIU and VRIII Link to Variable Rate Intravenous Insulin Infusion guidance
- Person with diabetes should be advised to:
Diabetes treated with tablets
- Stop Metformin 48 before PET scan
- Omit sulphonylurea (gliclazide/glipizide/glimepiride) prior to fast
- Take other diabetes medication as prescribed prior to fast
- See Radiological Procedures with Iodine Containing Contrast
- Follow guidelines on restarting Metformin
- Resume other usual diabetes tablets as prescribed post procedure
Diabetes treated with Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA)
- GLP-1RA (e.g. Liraglutide/Semaglutide) slow gastric emptying - individual assessment - can be omitted on the day of procedure
- Before restarting GLP-1RA exclude any contraindication after procedure e.g. pancreatitis or active bowel disease
Diabetes treated with insulin
- Support and advise in advance to achieve fasting glucose 5-7 mmol/L without hypoglycaemia
- In people prescribed multiple daily injection regimens, continue basal (long acting) insulin as prescribed. Basal insulin preparations include Lantus, Abasaglar, Levemir, Tresiba, Toujeo, Insulatard & Humulin I
- Basal insulin should be given as usual for people using multiple daily injection regimens
- Intravenous insulin can be prescribed to reduce glucose up until 90 minutes prior to PET scan
- Resume subcutaneous insulin regimen post procedure with food, for example
- In people prescribed multiple daily injection regimens, prescribe/recommend mealtime short/rapid acting insulin with meal post procedure
- In people prescribed twice daily biphasic insulin regimens, prescribe/recommend half the usual 'breakfast' insulin dose with lunch after (morning) procedure
In people using continuous subcutaneous insulin infusion (CSII) pumps
- CSII should be disconnected prior to and during X-ray procedures, CT and MRI scanners as these procedures can interfere with the CSII pump operation
- In general, CSII pumps can be disconnected for up to one hour without harm
- If the procedure is planned to take more than one hour, or the length of procedure is unknown subcutaneous or Variable Rate Intravenous Insulin Infusion(VRIII) will be required to reduce the risk associated with insulin omission Link to Variable Rate Intravenous Insulin Infusion guidance
- CSII can be restarted by the patient immediately after the procedure providing the person is alert and able to self manage
Seek advice from the Diabetes Team if required
Basic Guideline for management of insulin for short fast, minor surgery
Basic guidelines for management of non insulin medication for short fast/minor surgery
Back to the top of this page
Back to the top of this page
Back to the top of this page