Does anyone have suggestions on how to convey to the Doctor who will be doing my surgery, that I definitely want to be in charge of my own blood sugar management and don’t want either the pump or my cgm to be removed? TIA
I’m scheduled to have surgery next week. I basically told my surgeon that I will take care of my blood sugars and he can take care of the surgery. I will talk to the anesthesiologist the day of and tell him the same thing. I will also ask the surgical nurse to take my blood sugar about halfway through the surgery in case I need a boost of dextrose.
As for my responsibility, I will use a temp basal and test right before I am sedated.
Good Luck!
Sarah 
here’s another discussion about surgery w a pump, and it has links to other helpful discussions
I’m curious how this works out with a pump. I had major abdominal surgery about 7 years ago when I was still on MDI, and had to spend 3 days in the hospital for the initial recovery. I ran into this craziness that when you’re in there, THEY have to administer any and all medications, whether said meds are related to the reason you’re there or not. First morning after surgery they came in with a syringe and bottles of R and NPH. I dug in my heels–I’d been out of the R/N prison for years and I don’t think I even knew what doses to take of that stuff by then. In the end we worked out a deal where I could dial in the doses on my Lantus and Novolog pens and then they would do the actual injection. Which was silly enough in practice that they just looked the other way and let me do it.
I guess with a pump that whole “We aren’t allowed to let you administer your own meds” thing is moot since it’s classified as a prosthetic device. If so I wish I’d had one then. But my surgery took something like 4 hours and I’d have thought that kind of a long time to be unconscious with an insulin pump attached–I’m curious how they accommodate that.
Doctors wont touch a pump, in general. If the anesthesiologist has to adjust your bg’s when you are “out”, he/she will do that with medication (insulin, glucose). They always want patients running quite high, for surgery. I always reassure them that I’m steady at around 120-125 when I go in for procedures. they freak if we are under 100. 
I’ve worn my pump numerous times during surgeries. They will periodically monitor bg’s if you are out for a while. It ain’t no big thing.
I’ve run into this with hospital and day-surgery medical professionals. I get where they’re coming from. A severe hypo during surgery is a bad situation. What I don’t understand is their willingness to put you into sustained hyperglycemia and greatly increase your vulnerability to acquire an infection. Studies have shown that high BGs increase the odds of infection and delay healing, especially the immediate healing needed to recover from surgery. Hospital infections these days can kill.
I don’t play their game. I don’t run very high when I go in for surgery and my pump keeps me reasonably level. After all, it’s my body; not theirs
I have a feeling that I will be so nervous and anxious that not only will my blood pressure be high but my blood sugar will also be high. 
But “they” are ones who will be sued if anything goes wrong. A good relationship with your surgeon is essential I always err on the high side when going into surgery and do a temp basal. The anesthesiologist is responsible and will monitor your blood sugars and adjust as needed. I would much rather run high for a few hours than risk going into a hypoglycemic episode while under anesthesia.
You’re right Terry4. High blood sugars do delay healing. In numerous occasions, I’ve seen surgeries cancelled because the patient’s BG is high. The anesthesiologists that I know would most likely cancel surgery, if elective, and opt for a time when the bgs would be better controlled. However, if the surgery is urgent, and the docs see no hope for having a time of better control, they have no choice but to allow the surgery to be performed. They would consider the old question: is surgery beneficial or detrimental to the patient?
Thank you, barbraann. You are exactly right (except I don’t think that the first thing in the anesthesiologist’s mind is a law suit). The anesthesiologist is responsible for ordering blood sugar testing during the surgery (not the RN, although he may order he/she to do the testing), and it is better to be a bit on the high side than to have to deal with low blood sugars during surgery. Most folks don’t realize all the things that the anesthesiologist must deal with during surgery, and low blood sugar just complicates things. However, if hypoglycemia does occur, the anesthesiologist is well equipped to deal with that also.
Mayumi, anesthesiologists have meds readily available to counter high blood pressure and high blood sugars 
As far as “high” blood sugars, it’s not the high that occurs during or just before or after surgery. The poor healing occurs when your blood sugars have been running high for a long period of time. Having a high for the interim, while under surgery is not a problem. Having consistently high blood sugars before during and after a surgery, or basically uncontrolled sugars, is the problem or at least that’s what I have been told.
Exactly, barbraann, exactly.
HUGS Sarah…Hope it goes well.
HUgs Mayium…Hope it goes well and I am sure you will fine!
I use an Animas Vibe pump and a Dexcom CGM. About 2 months ago, I underwent a procedure involving day surgery (repair of an umbilical hernia) and a general anaesthetic. The anaesthesia lasted around 45 mins. The surgery was carried out at the hospital where my Diabetes Clinic is located, and the surgery team liased with the Diabetes team. I was scheduled for the first procedure in the morning which meant getting up at around 4 am in order to be at the hospital at 7.00 am. I had to fast for at least 12 hours and we agreed that I should aim to have my BG at around 8 mmol/L. In fact my CGM Lo alarm went off at around 4.00 am with my BG at around 3.5. With a couple of glucose tabs and some judicious use of a Temp Basal, I managed to tweak it up to around 5.5 by the time I arrived (still lower than I would have liked).
I showed the anaesthesiologist how to access my CGM readings on the pump and also how to disconnect in case of “emergency”. My BG was tested by fingerstick at least 4 or 5 times in the couple of hours before administration of the anaesthetic. Last thing before administration of the anaesthetic, I set a -50% Temp Basal. I was in recovery by mid-morning and re-set my basal to normal. I was allowed home around 5.30 pm. During the day my CGM readings (and the numerous fingersticks by the nursing team) sat fairly steadily at around 8. I had some lunch (soup and a roll) and bolused for it as normal.
All straightforward and 10/10 for the surgical and nursing team! I don’t think they had dealt with many adult pump patients (in Scotland pumps are much more common with chlldren) and they were actually very impressed with how steady my levels remained during the day. I found them helpful and interested!
All in all a good experience.
Joel
Joel ~
I’m glad you had a positive outcome to your recent surgery. It sounds like your surgical team was open to learning about pumps for adults.
Mayumi
I’d forgotten that there is one upside to having T1 if you’re going in for surgery: they almost always bump you to the head of the list. Of course you do have to get up early…