Managing My Diabetes During Those Special Times

By Peter Huynh, PharmD, CDE and Rhea C. Smith, PharmD

Getting ready for a colon exam

A common question many people using diabetes medications have is: “What do I do with my medications if I am having a colonoscopy [koh-luh-NAH-skuh-pee]?”

What is a colonoscopy and why is it recommended? A colonoscopy is a common medical test. During a colonoscopy, your doctor can see inside your colon and rectum. The colon is part of the large intestine and the rectum connects the colon to the anus. The procedure is used to look for early signs of cancer and to diagnose other problems, such as bleeding and inflamed intestines.

How do you prepare for a colonoscopy? On the day before your colonoscopy, you will be asked to change to a clear liquids diet. If you have diabetes, you can’t change your diet or meal schedule without planning so that your blood glucose (sugar) can be properly managed. A helpful tip is to schedule your appointment for colonoscopy early in the morning. This will allow you to minimize missing meals and minimize having to restrict your fluid intake. Check your blood sugar before your exam and again before your post-exam meal. Always check if you have symptoms of low or high blood sugar at any time. Although this may not be possible for you to do while you are sedated for your colonoscopy, you can ask to have this done for you during the procedure. Remember to bring your blood glucose meter and test strips with you on the day of your exam!

Some diabetes medications can increase the risk of hypoglycemia [hie-poh-gly-SEEM-ee-ah] (low blood sugar) when your normal daily schedule of meals is changed. For example, insulin, glyburide [GLY-byoo-ride], glipizide [GLIH-pih-zide], glimeperide [gly-MEH-puh-ride], repaglinide [ruh-PAH-glih-nide], and nataglenide [nuh-TAH-gluh-nide] should be reviewed with your doctor. Your doctor will tell you what changes to make to dose or frequency of use as you get ready for your procedure. These medications can be taken in combination with other glucose-lowering medications and may have different names. If you have any questions about your medication, ask your healthcare team. Medications that lower blood sugar are usually stopped or decreased on the day before your exam and stopped on the day of the colonoscopy exam. If you are on insulin, you will need to contact your provider for specific instructions in decreasing your insulin. If you are taking any blood-thinning agents, they may need to be adjusted up to 10 days before your colonoscopy. Non-prescription medications that need to be avoided are aspirin, aspirin-containing products, and non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen. Please contact your healthcare team on how to manage these medications before you have the exam.

Blood Glucose Management During Illness

Your diabetes care can also be a challenge when you are sick with a cold, the flu, or have symptoms of vomiting and/or diarrhea. People with diabetes often think to decrease their diabetes medication use when ill, thinking that as you are not eating your normal diet, you automatically need less glucose controlling medicine. But that’s not true! Do not stop your glucose medications!

Often you may feel too ill to check your blood sugar. However, it is the very time when attention to your diabetes can be the most critical!

During illness, you are at a higher risk of developing hyperglycemia [hie-per-gly-SEEM-ee-ah] (high blood sugar) which could lead to sleepiness, confusion, and even coma, especially if you have type 1 diabetes (the type of diabetes in which your pancreas can no longer make insulin). Illness stresses your body, resulting in the release of hormones that help you get over your illness; but, unfortunately, these hormones can increase blood sugar even without food.

To prevent high blood sugar from getting out of control and making you have to go to the hospital, there are three key areas of focus: medications, checking (blood sugar and ketones), and fluids/food.

Medications

  1. Insulin: continue taking your normal insulin doses because your blood sugar may keep rising no matter whether you are eating or not. You might even need more insulin if your blood sugar continues to rise on your typical insulin doses.
  2. Pills for controlling your glucose: unless your doctor tells you otherwise, continue taking all of your oral medications. Contact your healthcare team for help adjusting dosages if you are throwing up and cannot keep your pills down. If you are unable to keep anything down, contact your healthcare team as soon as possible!
  3. Ask nearby family members or close friends to pick up your medications from the pharmacy or prepare your meds while you are ill. This can help ensure that you take the right pills and the right doses, because you have “another pair of eyes” to check pills and doses.

Check, check, check your blood glucose and urine ketones:

Frequent blood sugar and urine ketone checks will help prevent as well as allow better treatment of hyperglycemia. Checking can prevent complications such as diabetic ketoacidosis [KEE-toe-ah-sih-DOE-sis], as you will know if you need to get help or are getting better. Ketones should be checked if you have type 1 diabetes and have high blood sugar readings. However, ketones are also possible in people with type 2 diabetes.

The following are guidelines for monitoring your blood sugar and urine ketones:

  1. Check blood sugar and ketones every two to four hours.
  2. Record blood sugar readings and insulin doses to keep records of trends.
  3. Contact your doctor if your blood sugar goes up and stays above your usual readings. Definitely contact your doctor if your blood sugar readings are above 300 and not coming down and you have ketones in your urine after checking 2 or more times in a row.

Fluids/food:

When you are sick your appetite might not be normal, but it is important that you keep up your fluid intake. Food intake is not critical, but just water alone will not help your body to balance minerals and nutrients, which are needed to get you well again. Easily digested foods and liquids can contain small amounts of carbs (sugars) that your body can use as an energy source. This will help prevent fat breakdown that results in ketoacidosis, which would require you to go to the hospital for treatment.

Along with knowing how to manage diabetes during illness, it is also important to know when to contact your doctor. Symptoms such as throwing up, inability to keep hydrated, and worsening conditions should always be signals for a call to your healthcare team for advice. An even better plan is to not wait until you are ill; instead, discuss with your doctor what a sick day plan should look like, so that you aren’t unprepared when you get sick!

Dr. Huynh is a clinical pharmacist and Certified Diabetes Educator at the University of Washington, Diabetes Care Center. He graduated at the University of Connecticut with his Doctor of Pharmacy, and has completed a diabetes research fellowship at Washington State University. He is actively involved in direct patient care and plays and active role in the diabetes education program at the University of Washington, Diabetes Care Center.

Dr. Smith is a clinical pharmacist at the University of Washington, Diabetes Care Center. She graduated at the University of Washington in 2007 with her Doctor of Pharmacy, and has completed her general practice residency at UW Medicine in Seattle, Washington. She is actively involved in direct patient care and plays an active role in the diabetes education program at the University of Washington, Diabetes Care Center.