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Diabetes

Adjusting your diabetes medicine and diet for a gastroscopy or EGD (Esophagogastroduodenoscopy)

​​The guidelines below will help you adjust your diabetes medicine and diet as you get ready for your test.

If you see a diabetes educator or diabetes specialist, contact them at least 1 week before your test to ask about adjusting your diabetes medicine or insulin.

Diet

  • Follow the instructions the gastroenterology (GI) Clinic gives you about what you can eat or drink before the test.
  • If your test is in the morning, don’t eat or drink anything after midnight.
  • If your test is in the afternoon, you can only have clear fluids in List 1 or 2 (below) until 4 hours before the test.
  • If your blood sugar drops below 4.0 mmol/L or if you have symptoms of low blood sugar, take 15 grams of a carbohydrate-containing fluid from List 1. Test your blood sugar again in 15 minutes. If your blood sugar is still low, take another 15 grams of carbohydrate-containing fluid from List 1.
List 1 - Fluids that have sugar (Each has about 15 grams of carbohydrates)List 2 - Fluids that aresugar-free (Choose as desired)
  • Black tea, coffee, or water with 1 rounded tablespoon (15 mL) sugar or honey
  • ½ cup (125 mL) regular Jell-O®
  • ½ cup (125 mL) regular (sugar sweetened) Kool-Aid®
  • ¾ cup (175 mL) fruit drink or fruit juice without pulp (e.g., apple, white grape)
  • ¾ cup (175 mL) regular pop
  • 1 cup (250 mL) sports drinks (e.g., Gatorade®)
  • Water
  • Clear bouillon, broth, or consommé
  • Diet pop
  • Diet Kool-Aid® or Crystal-Lite®
  • Black coffee or tea
  • Diet popsicle
  • Diet Jell-O®

Testing your blood sugar

Test your blood sugar anytime you feel your blood sugar is low or high.

  • Test your blood sugar at least every 4 hours. Blood sugars in the range of 8 to 12 mmol/L are fine for these 2 days, even if it’s higher than your usual target.
  • If you have type 1 diabetes or you are on an SGLT2 inhibitor, like canagliflozin (Invokana), dapagliflozin (Forxiga), empagliflozin (Jardiance) and ertugliflozin (Steglatro) and your sugars are over 14 mmol/L, test your urine or blood for ketones.
    • If positive for ketones, you may need extra insulin. Moderate to large ketones may mean that you’re in DKA (diabetic ketoacidosis) and need to go to the Emergency Department right away.
  • If you’re worried about your blood sugar level, speak with your healthcare provider or diabetes educator.

Adjusting your diabetes medicine

If you take insulin

The day before your test
  • All doses stay the same at breakfast, lunch and supper.

Evening/Bedtime

  • Basal Insulin: Reduce your dose of basal insulin (Humulin N, Novolin NPH, Lantus, Basaglar, Toujeo, Levemir or Tresiba) by 25% or the amount your healthcare provider tells you. Tresiba may need to be reduced for 2-3 days before the procedure. Talk with your healthcare provider.
    Your dose will be units.
  • Insulin Pump: You may need to reduce your basal rate by 10% to 20% overnight if there are concerns about low blood sugar. If there are no concerns, keep the same basal rate.
Test day

Morning

  • Bolus (meal) Insulin: Don’t take your morning bolus (meal) insulin (Apidra, Humalog, NovoRapid, Fiasp, Humulin R, or Novolin Toronto).
  • Premix Insulin: Don’t take your morning premix insulin (Humulin 30/70, Novolin 30/70, or Humalog 25/75​).
  • Basal Insulin: Reduce your dose of basal insulin (Humulin N, Novolin NPH, Lantus, Basaglar, Toujeo, Levemir or Tresiba) by 25% or the amount your healthcare provider tells you. Tresiba may need to be reduced for 2-3 days before the procedure. Talk with your healthcare provider.
    Your dose will be units.
  • Insulin Pump: You may need to reduce your basal rate by 10% to 20% if there are concerns about low blood sugar. If there are no concerns, keep the same basal rate.

*Be sure to bring a source of fast-acting sugar and your blood glucose meter with you.

After the test

  • Premix Insulin: Reduce your morning dose of premix insulin (Humulin 30/70, Novolin 30/70 or Humalog 25/75) by 25% (or the amount your healthcare provider tells you) for your first meal after the test. Your dose will be ______________ units.
  • All other insulin: Take as prescribed.

If you take diabetes medicine other than insulin

The day before your test
  • Take your medicine as normal or as your healthcare provider tells you.
Test day
  • Don’t take any diabetes medicine until after your test is done and you’re eating. Then take it as per your scheduled dose.

*Be sure to bring a source of fast-acting sugar and your blood glucose meter with you.

For 24/7 nurse advice and general health information call Health Link at 811.

Current as of: July 10, 2020

Author: Endocrinology and Metabolism Program, Alberta Health Services