University of Michigan Health System

This information is approved and/or reviewed by U-M Health System providers but it is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your physician or make an appointment to be seen if you have questions or concerns about this information or your medical condition.| Complete disclaimer

Instructions For Patients With Diabetes Having Outpatient Procedures/Tests

If you manage your diabetes with insulin (or insulin and pills for diabetes):
For patients with diabetes, any test or procedure that causes you to miss a meal or change your usual meal plan will require special planning to safely manage your blood sugar. Because the timing of your meals and medicines will be different than usual, your blood sugar level is also likely to be different than usual and you will want to watch it closely. You should test your blood sugar at dinner and bedtime the night before the procedure and first thing in the morning of the procedure.

• You should continue to check your blood sugars every 1 – 2 hours up to and right after your procedure has ended. Also, check your blood sugars whenever you feel that you might be experiencing low blood sugars or very high blood sugars. Bring your blood glucose monitor and blood glucose strips with you to the procedure.
  

• Be sure to tell the nurse, doctor or technician if you think you are having a low blood sugar reaction during the procedure. Bring a source of sugar, should it be needed: glucose tablets, glucose gel, sugar packets. All can be used to treat a low blood sugar.
  

• If you have Type I diabetes (IDDM), you should also check your urine for ketones when your blood sugars are greater than 240 mg/dl. If ketones are moderate or large, contact your health care provider to manage this condition.
  

• If you have a low blood sugar reaction while preparing for a test, you must treat it. Besides the items listed above, you can use ½ cup apple juice or ½ cup cola (clear liquid with carbohydrate)
  

• If it is possible, schedule your appointments early in the day so that after the procedure, you may eat and take your diabetes medicine as close to your usual time as possible.
  

Here are some examples of how to manage your medications.

• If you manage your blood sugar with one shot of insulin in the morning: Take ½ of your usual dose of long acting insulin the morning of the test. Long acting insulins include:NPH, Lente, 70/30, 75/25, Lantus and Ultra-Lente. Take no short acting insulin the morning of the test. Short acting insulins include:Regular,Humalog,Novolog. Take the other ½ of your long acting and any regularly scheduled dose of short acting insulin right after the test. Be sure to eat your usual meal at that time.

• If you manage your blood sugar with one shot of long acting insulin in the evening. Take ½ of your usual dose of long acting insulin the evening before the procedure. Take no short acting insulin the morning of the test.
  

• If you manage your blood sugar with two shots of insulin (morning and evening): If you will have your usual dinner, take your usual evening dose on the evening before. If you will have only clear liquids the evening before, take only ½ of your usual evening dose of long acting insulin. Take ½ of your usual morning dose of long acting insulin on the morning of the test day. Take no short acting insulin the morning of the test. Take the other ½ of your usual morning dose of long acting insulin after the test if the test ends before noon. Again, it is important that you eat your usual meal at this time. If the test is scheduled or lasts into the afternoon, resume your normal evening dose of insulin the evening of the test day.

• If in addition to two shots of insulin as above, you also take short acting insulin at lunch time and/or at bedtime. Follow the above instruction. Take bedtime short acting if needed. If your test is completed by your usual lunch time, you can take your short acting insulin along with the rest (1/2) of your long acting insulin, with your lunch.
  

• If you manage your blood sugar with long acting insulin in the evening and several shots of short acting during the day:
  Take ½ your usual dose of long acting insulin the evening before the procedure. If you can have dinner, take your usual dose of evening short acting insulin. If you are on clear liquids only and can replace the “carbs”, take short acting insulin. (see chart)

• Take no short acting insulin the morning of the test.

• Take your usual short acting insulin as soon as you are able to have a meal.

• Resume your usual dose of long acting insulin in the evening.
  

If you also take diabetes pills to manage your blood sugars:

• If your procedure is completed by your usual lunch time: Do not take your diabetes pills the morning of your procedure. Bring your pills with you and take them as soon as the procedure is over and you can eat. Evening pills can be taken at the usual time.
  

• If your test is scheduled or lasts into the afternoon, skip your morning pills completely the day of the test. Take your evening pills at the usual time, and eat your usual evening meal.
  

NOTE: If you take any Metformin containing pills (Glucophage, Glucovance, etc.) to control your blood sugar: For procedures that inject dye (CT scans, IVP, some Angio procedures), you will need to be off of your Metformin containing pills the entire day of the test and for two days after the test. A blood test for kidney function will need to be done before you restart these pills. Please speak to your doctor or nurse about this.

Clear Liquids
Clear liquids are all counted as fruit exchanges. You will replacing all of your carbohydrates (starches/breads, milk, fruit, and vegetables) with only simple carbohydrates. These are digested more rapidly and you will be more likely to have a low blood sugar reaction. Therefore it is recommended that you take your clear liquids in seven feedings, not three meals. Drink the liquids at breakfast time, mid morning, lunch time, mid-afternoon, dinner, 2 – 3 hours after dinner and at midnight. DO NOT take any clear liquids that are RED or PURPLE.

The following clear liquids are recommended:

Chicken or beef broth 1 cup O grams of carbohydrate
Apple Juice ½ cup 15 grams
White grape juice ½ cup 15 grams
Jello (not RED or PURPLE) ½ cup 20 grams
Popsicles (not RED or PURPLE) 1 cup 30 grams
Kool-Aid (not RED or PURPLE) ½ cup 10 grams
Carbonated beverages, not diet ½ cup 10 grams

*Coffee, tea, broth, clear diet sodas, and water may be taken at any time.

These are general guidelines. Please call the health care provider who manages your diabetes for questions.

Information provided by Lisa Sylvest, RN, BSN, UMHS GI Clinic, April 2008