Carolina digestive health associates
Carolina Digestive Health Associates
You are scheduled for a colonoscopy. Please read all of the attached information as soon as possible so you are
PHYSICIAN PERFORMING PROCEDURE
Please closely follow the instructions below in prepping for your procedure. It is very important that you follow
them carefully, or we will be unable to perform the procedure and it will be cancelled.
This packet includes:
Instructions for 5 days and 3 days prior to your procedure
Instructions for the day prior to your procedure
This information should answer most of the questions you may have about your procedure. If you still need
additional assistance, please contact our office as soon as possible.
As a reminder, if you cancel your procedure less than 3 business days before your scheduled appointment, you may
You must have a responsible driver with you at all times when you are at the endoscopy center/hospital. You should
expect to be at the endoscopy center/hospital between 2 ½ and 3 hours.
Exception: If you are scheduled for a flexible sigmoidoscopy and you are NOT going to be sedated, then you may
drive yourself home after your procedure.
5 DAYS BEFORE PROCEDURE:
• Discontinue taking medicines that may thin your blood, such as: COUMADIN, PLAVIX, TICLID, Heparin, Aspirin,
Percodan, Alka Seltzer, Empirin, Ecotrin, Bufferin, Ascriptin, Ibuprofen, Motrin, Advil, Medipren, Nuprin,
Naproxen (Naprosyn), Aleve, sulindac, Clinoril, Piroxicam, Feldene, Indomethacin, Indocin, Diclofenac and Voltaren
unless otherwise directed by your physician. If any of these are a medical necessity for you, please inform us NOW.
• Please stop all iron products (multi-vitamins) during this time as well. This includes Fish Oil.
• IF YOUR DOCTOR HAS PRESCRIBED ASPIRIN:
Please decrease your aspirin to 81 mg a day. You will be informed after your procedure when you will be able to resume your regular dose.
• IF YOU TAKE ASPIRIN AND IT IS NOT PRESCRIBED BY YOUR DOCTOR:
Please discontinue your aspirin 5 days prior to your procedure. You may take Tylenol or other brands that contain acetaminophen
• Tylenol & other brands that contain acetaminophen are safe to use prior to this procedure.
• *** If you do not see your medication or supplement listed here, you may take it. ***
3DAYS BEFORE THE PROCEDURE:
• Stop eating CORN, BEANS, CELERY, LETTUCE, TOMATOES, RAW FRUITS, SEEDS, and NUTS until after your
• Pick up supplies from your pharmacy (see shopping list)
DAY OF THE PROCEDURE
• If you take Blood Pressure Medications, Heart Medications
, or Seizure Medications
take your medicines as soon as
GENERAL INSTRUCTIONS FOR DIABETIC PATIENTS
• Check your blood glucose during the preparation period, especially if you feel it is running too low.
• Your blood glucose levels may run higher than usual during this period due to adjustments in your diabetes medication. If
blood glucose becomes extremely high (greater than 350), call our office, your PCP or your diabetes doctor.
• For low blood glucose levels, sweetened clear liquids (such as apple juice with sugar added) is always permitted regardless
of whether you were instructed to take nothing by mouth (NPO) prior to the procedure. Inform the endoscopy nurse upon arrival if this was necessary.
• Resume your usual diabetic diet and medications immediately after your procedure(s) unless you are instructed to do
otherwise. If your diet remains restricted following the procedure, ask for instructions regarding diabetic medication adjustment.
If you are diabetic and having a Colonoscopy, or a Colonoscopy and EGD,
follow these instructions:
ORAL DIABETES MEDICATIONS
- If you take oral diabetic medications, stop these medications the
day before your colonoscopy. You will be on clear liquids only for most or all of this day. Restart these
medications after the procedure when you resume eating.
– If you take insulin of any type, follow these guidelines:
Lantus or Levmir -
Take your usual dose unless your blood glucose is tightly controlled (glucose levels
are usually in the normal range or are occasionally low). In that case, reduce the dosage by one forth on
the day before you begin your laxative prep (two days before your colonoscopy) and on the day of the
prep (the day before your colonoscopy). Resume your usual dose after the procedure.
70/30 or 75/25 insulin -
Take half of your usual dose the day of the prep (the day before your
colonoscopy). On the morning of the procedure, take half of your usual dose or, if you have a procedure
before 11:00am, bring your insulin with you to take before your next meal. Resume your usual dose after
– If you take a set dose of insulin before each meal, stop this the day of the prep
(the day before your colonoscopy). Continue to take Sliding Scale Insulin as usual. Resume your usual
Sliding Scale Insulin
– Continue this as usual.
– Reduce the dose of your insulin by one forth or consult your endocrinologist for
recommendations. Resume your usual dose after the procedure.
MiraLAX- Morning Procedure (7-11 am)
NO SOLID FOODS UNTIL AFTER THE PROCEDURE
IF YOU EAT, YOUR PROCEDURE WILL BE CANCELLED
DAY BEFORE PROCEDURE
The day before your procedure, the only thing you can have is clear liquids. You will have nothing other than clear liquids until after your procedure has been completed. The clear liquid diet ends four (4) hours before your procedure; at that point you must have nothing further.
• You may have water, clear fruit juices (white grape, apple), soda (Sprite, Ginger Ale, Pepsi, Coke, and
diet colas), Jell-O, ice pops, broth, bouillon, coffee, tea, gatorade
• You may NOT have anything red, purple, blue, or orange
• You may NOT have milk or milk products (this includes non-dairy creamers)
TAKING YOUR PREP MEDICATIONS
Take 2 (5mg) bisacodyl (dulcolax) tablets with an 8 oz glass of water. These tablets can be purchased over the counter.
Do not crush, break, or chew them. Do not take the tablets within 1 hour of taking an antacid (e.g. Pepcid, etc).
Mix the 238g (8.3oz.) bottle of MiraLAX with 64 oz of a non-carbonated clear liquid of your choice. Stir until the
powder dissolves completely. Drink one 8 oz glass every 10 to 15 minutes until the solution is gone.
Mix 3 caps full of the 119g (4.1 oz.) bottle of MiraLAX with 24 oz of a non-carbonated clear liquid of your choice. Stir
until the powder dissolves completely. Drink one 8 oz glass every 10 to 15 minutes until the solution is gone.
***After finishing this dose of MiraLax, you may have clear liquids up until 4 (four) hours before your procedure
time. During the 4 (four) hours before your procedure, you may not have anything to eat or drink, including:
water and all other clear liquids, gum, candy, chewing tobacco, snuff or food items. ***
YOUR STOOLS SHOULD BE LIGHT YELLOW OR CLEAR WITH NO PARTICLES. IF THIS IS NOT
THE CASE, PLEASE CONTACT YOUR PHYSICIAN.
Your Shopping List
Items to purchase from your pharmacy:
_____ MiraLAX 238g (8.3 oz.) bottle – This is over the counter. You may substitute with a generic
_____MiraLAX 119g (4.1 oz.) bottle – This is over the counter. You may substitute with a generic
_____ 2 (5mg) bisacodyl (dulcolax) tablets – This is over the counter.
Examples of clear liquids you may purchase from any store:
______ ICE pops – ONLY YELLOW OR GREEN-
_____ Yellow, green or clear colored Gatorade
_____ Clear fruit juice - white grape or apple
______ Soda - Sprite, Ginger Ale, Pepsi, Coke,
DO NOT HAVE ANYTHING RED, PURPLE, BLUE OR ORANGE
DO NOT HAVE MILK OR MILK PRODUCTS (THIS INCLUDES NON-DAIRY CREAMERS
Colonoscopy lets the physician look inside your entire large intestine, from the lowest part, the rectum, all the way
through the colon to the lower end of the small intestine. The procedure is used to diagnose the causes of
unexplained changes in bowel habits, signs of cancer in the colon and rectum, inflamed tissue, abnormal growths,
For the procedure, you will lie on your left side on the examining table. You will be given medication to keep you
comfortable and to sedate you during the exam. This medication has a slight amnesic effect so you may not
remember the procedure. The physician will insert a long, flexible tube into your rectum and slowly guide it through
your colon. The scope also blows air into your colon, which inflates the colon and helps the physician see well.
Most of the air is removed as the examination is finished.
Your physician may biopsy tissue and/or remove polyps by using tiny instruments passed through the scope. All
(biopsy) tissue is sent to the lab for testing. If there is bleeding in the colon, the physician can use instruments
Your colon must be completely empty for the colonoscopy to be thorough and safe. To prepare for the procedure,
you must follow a clear liquid diet and use a laxative solution the day before the procedure. DRINKING LIQUIDS
AFTER THE RECOMMENDED TIME FRAME MAY CAUSE ASPIRATION, MEANING THE FLUID COULD
GET INTO THE LUNGS AND CAUSE LIFE THREATENING COMPLICATIONS. Please see the attached sheets
Colonoscopy takes 10-45 minutes, however, you will need to plan to be at the endoscopy center / hospital for 2 ½ to
3 hours. The medicine given for sedation should keep you from feeling discomfort during the exam.
DIABETES MELLITUS TYPE 2 Lifestyle modification as part of initial management Measure HbA1c every 3 months depending on Have lifestyle modifications been successful? Consider oral hypoglycaemic agents Is there renal and/or cardiac dysfunctionConsider either metformin or a sulphonylurea Optimise dose of oral hypoglycaemic agent If patient on sulphonylurea and has normal renal
rearrangement is initiated by the presence of a heteroatomJ 0.8, 2.2 Hz, 1H), 6.50 (d, J 12.4 Hz, 1 H), 6.17 (dd, J 1.3,and there must be other reactions similar to this one. 12.4 Hz, 1H), 4.97 ± 4.93 (m, 2 H), 1.18 (s, 9H); 13C NMR (50 MHz,CDCl3): d 153.9, 153.7, 145.0, 132.3, 129.9, 129.8, 127.2, 125.5, 121.4,111.3, 110.7, 106.6, 35.9, 29.3. 17: 1H NMR (300 MHz, CDCl3): d 7.