Low Fibre Diet for Diabetes

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Introduction

This leaflet is for Diabetic patients who are preparing for colonoscopy to guide them on the low fibre diet required and the taking of Senna before a colonoscopy procedure. This is a particularly important part of the preparation for the colonoscopy.

Patients with diabetes, have slower motility than patients without diabetes and are therefore more prone to constipation. Therefore, by adding in senna for 5 days along with the low fibre diet helps to make sure the bowel is clean for the procedure and that the endoscopist can see everything clearly.

Taking Senna Tablets, when do I start and how do I take them?

To ensure that the bowel preparation works to the maximum efficacy we are asking ALL diabetic patients to take 5 days of senna tablets, which is two senna 7.5mg tablets every evening with a full glass of water. In some cases, you may need to use your own supply to be able to start this at the correct time, however, once you have had your pre-assessment appointment you will be sent a supply for 7 days to replace your stock.

You would then commence the low fibre diet after 2 days of senna.

On the day before your procedure, you would have your final light meal and no more senna but would then take the oral bowel preparation as per the instructions from the pre-assessment nurse.

To simplify please follow the instructions set out in the table below.

Day 1	Senna x2 with full glass of water	Normal diet
Day 2	Senna x2 with full glass of water	Normal diet
Day 3	Senna x2 with full glass of water	Commence low fibre diet
Day 4	Senna x2 with full glass of water	Low fibre diet
Day 5	Senna x2 with full glass of water	Low fibre diet
Day 6	No senna
	AM appointment: both doses of bowel prep: Timings will be discussed at pre-assessment	Final meal -light breakfast Timing will be discussed at pre-assessment
	PM appointment: 1^st dose of bowel prep Timing will be discussed at pre-assessment.	Final meal – light lunch Timing will be discussed at pre-assessment
Day of procedure	PM appointment: 2^nd dose of bowel prep Timing will be discussed at pre-assessment.	NO FOOD

What is a low fibre diet?

A well-balanced diet contains fibre that helps with digestion and absorption of nutrients and water. However, it also helps bulking in stools (poo) and this diet can leave behind residue when preparing for a colonoscopy and makes seeing and performing the procedure harder.

Please eat a low fibre diet which helps to ensure your bowel is clean for the procedure.

When do I start the low fibre diet?

3 days before your procedure is optimal, only eat a low fibre dietand start taking your Senna tablets.Low fibre foods are the foods listed in the green column in the table below. Do not eat any high fibre foods, these are the foods listed in the red column.

On the day before the colonoscopy, you will need to follow the instructions on the bowel preparation sheet given to you by the nurse. It is important that for your last meal you eat an exceptionally light choice e.g.: cereal from allowed list or white toast only.

Food Type	Food ALLOWED	Food to AVOID
Bread, cereals and Flour based products	White bread, English muffins, plain scones/ croissants/ bagels without dried fruits, crumpets, pancakes, white pitta and naan bread, white chapatti, and tortillas, poppadums, Yorkshire pudding, dumplings Refined breakfast cereal, such as Special K, Cornflakes and Rice Krispies with no dried fruit/nuts White rice, pasta, noodles, tapioca, semolina Corn/ white flour Plain biscuits such as rich tea/ custard creams Plain crackers Plain sponge cake	Wholemeal, granary, or rye bread, chapatti and pitta bread, fibre enriched bread, All fruit / nut breads, including walnut, granary or fruit muffins or scones and pastries with fruit/ dried fruit. Wholegrain cereals, such as Weetabix, All Bran, porridge oats, muesli, bran, wheat germ and bulgar wheat. Wholegrain and wild rice, pasta, couscous, pearl barley, quinoa, oatmeal, wholegrain noodles Brown, whole meal or granary flour, wheat germ Wholegrain or fruit/ nut biscuits (fig rolls, Garibaldi) Oat biscuits, whole wheat biscuits e.g., flapjacks, whole wheat digestives, fruit cake, rye crispbreads
Meat, legumes, and nuts	Any tender and soft meat, chicken, and fish. Smooth paté (crab, tuna, mackerel, chicken liver) Tofu Eggs Smooth paté (crab, tuna, mackerel, chicken liver)	All beans, lentils, and chickpeas All nuts including coconut. All seeds, including pumpkin, chia, sunflower, and sesame seeds. Plant based protein powders (pea protein, flaxseed protein)
Dairy products, fats, and oils	All types of milk and milk alternatives, cream, sour cream, crème fraiche, cottage cheese Smooth yoghurt and fromage frais (no nuts or fruit) Most cheeses	Any milk and products containing fruit, nuts, seeds, or cereals.
Vegetables	Allowed foods (flesh only – no peel / skin, seeds, or stalks), Cooked boiled/ mashed potato, sweet potato, pumpkin/butternut squash, zucchini (courgette) cauliflower and broccoli tips, asparagus tips, aubergine, marrow, carrot, swede, beetroot. Sieved tomato sauces/ tinned tomatoes, including passata and tomato puree. Strained vegetable juices Allowed foods (salad) Skinless and seedless cucumber and tomato Shredded lettuce, young spinach, rocket (chew thoroughly)	Avoid these foods (all raw vegetables) Avoid all other vegetables not listed in ‘Allowed’ list Including artichoke, cabbage, curly kale, celery, fennel, leeks, okra, peppers, peas, mature spinach, sprouts, sweetcorn, yam, cassava, Salad/ roast/ croquette potato and chips
Fruits	Allowed foods: flesh only (no peel/ skin, seeds) Pawpaw, melons, banana (ripe), seedless grapes Peeled/ canned/ stewed or well-cooked peaches, nectarine, apple, pear, plums, fruit cocktail, mango, lychees, apricot. Canned fruits except pineapple/ prunes Fruit juice – no pulp Avocado (smooth, guacamole)	Avoid these foods: fruit with skin, pips or of a very “fibrous” texture. Apples, pears, pineapple, citrus fruit, berries, and currants Dried fruit Canned pineapple, prunes All other fruit not ‘Allowed.’ Smoothies
Drinks	Strained fruit and vegetable juices, milk and milk alternatives, water, soft drinks, tea and coffee, herbal teas	Fruit and vegetable juices with pulp, prune juice Fruit and vegetable smoothies
Miscellaneous	Smooth or sieved soup All fats including butter, oil, margarine Sugar, honey, golden syrup, custard powder, boiled sweets, mints, toffee, caramel, marshmallows, plain/milk/white chocolate Seedless jam and marmalade Sorbet, ice cream, jelly, smooth puddings (custard, rice pudding, semolina, tapioca, mousse) Pepper, salt, herbs, and spices in moderation (dried or finely chopped) Bovril, Oxo, Miso soup with no seaweed, marmite Smooth sauces (gravy, ketchup, soy sauce, tamari) Plain crisps, plain pretzels (without sesame seeds) Smooth nut butter

Meal Ideas:

Breakfasts:

Low fibre cereal (from allowed list) with milk and banana.
White toast or bagel with spread and cottage cheese/marmite or jam (seedless)
Scrambled/boiled or poached egg and white toast with spread.

Lunch Ideas:

White roll/bread with spread and cheese/ham/cottage cheese/egg or fish.
Creamy soup and white bread/toast with spread.
Jacket potato (NO SKIN) with spread and cheese/tuna and mayo (NO sweetcorn)

Dinner Ideas:

Potato (NO SKIN) white rice/pasta with fish/meat/egg/cheese/creamy sauces or stews.
Small portion of vegetables (see allowed list)
Cheese omelette
Pudding: Sponge and custard, jelly, or smooth yoghurt.

Snack Ideas:

Plain biscuits, smooth yoghurt, crumpet with jam or marmite, fruit (see allowed list)

Contact Details:

If you have any specific concerns about your procedure, that you feel have not been answered and need explaining, please contact the following:

Alexandra Hospital Redditch

Booking Office – 01527 505751
Endoscopy Nursing Staff – 01527 512014

Evesham Community Hospital

01386 502443

Kidderminster Hospital

Booking Office – 01562 826328
Endoscopy Nursing Staff – 01562 513249

Worcestershire Royal Hospital

Booking Office – 01905 760856
Endoscopy Nursing Staff – 01905 733085

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day. If you are unable to understand this leaflet, please communicate with a member of staff.

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Low Fibre Diet for Diabetes

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