I'm having surgery for fractured ankle which involves anesthesia. I've been having lots of surprise lows and am afraid I'll slip into coma while under during surgery. How often do they monitor BG during surgery and can I trust them to do it? Is it the doctor performing surgery or the anesthesiologist who is responsible for this?
What do you think about writing a reminder with black marker on my leg to check my BG? Can you tell I might be a control freak? Feeling a little apprehensive right now --a friend just died in the hospital while he was "under observation" for a perforated intestine. I just don't trust them. . .
I had an endoscopy last week, not with general but with “conscious sedation”. For all intents and purposes I was unaware. That is, I know, different from surgery and much briefer. They had me hold my insulin that morning so I was running a bit high and took my blood sugar before the procedure (150 which I actually felt good about at the time as I would rather be high when I am due to be sedated). I would talk to your surgeon ahead of time about your concerns and then talk to the nurses at the procedure. I brought along my own meter to make sure.
On June 26th 2009 I had a partial knee replacement and part of my pre op was a physical with an internest that had a diabetes proctice. He was reponsible for my care after surgery until my release. I felt very confident that they were doing all the correct things. The anesthesiologist was responsible while I was under.
A perforated intestine does have a high mortality rate. I’m sorry about your friend. Doctors don’t like people to die during surgery so they keep very good track of you in there and in the recovery room. I recommend a family member stay with you when you go back to the hospital floor.
I’ve had two reletively minor surgeries since being dxd. My health records and questionnaire form clearly said “TYPE 1 DIABETIC”. No problems during or after either surgery. The last one was an achilles tendon repair. I chose to go under general but I could have gone under local anesthesia if I chose to do so.
Maybe you’ll have the option for local anesthesia for your ankle repair?
I had surgery in the spring – very successfully – and made sure I told EVERYONE to test me. I talked to the doctor, to the preop nurse, anesthesia during preo op, preop resident who checked me in, the scrub nurses, and when I woke up in recovery the first question was what’s my sugar and they had an answer. The more people who know/are reminded the better. Its very hard to go into surgery when they have changed your meds for the day. I didn’t say please do it – I asked specifically WHO is going to do it meaning I want a name. The bottom line is your doctor is your best advocate. If he orders it - it gets done.
Thanks for replying everyone, I feel better about the surgery now! Oy, I’m such a worrier, I can’t help it. I get it from the Jewish grandmother Rosetta
Kathyann, I understand the treatment for perforated intestine is surgery, however, the doctor declined it and my friend was scheduled to be released. Then he perished. Maybe I don’t know the whole story but it seems so senseless to die in the hospital. Although that’s probably the place where most people die.
I have had surgery with anesthesia several times. I am not sure if they check you bg. But I always insist that there be no glucose in the IV. I leave my pump on and my basals are accurate enough to cover me. I test before the anesthesia is administered, and when I regain consciousness. Ask your endo about how to handle your situation.
Great suggestion from Susan about specifying no glucose in IV. A Type 1 friend was hospitalized for a procedure & given an IV bag with glucose. His wife had to do battle for him to keep his pump, but that’s another story.
Be clear that you’ll be in charge of your diabetes management with testing, meds, insulin. Have this written in your record.
Anything you’re given flack about, ask immediately to speak with the hospital administrator. Don’t waste time speaking with doctors & nurses.
I think the black magic marker is a great idea! Sure couldn’t hurt & will give you peace of mind.
I had a tonsillectomy + adenoidectomy over Thanksgiving break… only a 45 min. procedure. I tested before I went in, I tested when I got out (and yeah they put glucose in the IV bag… my numbers were fine before and a bit high afterward. I should’ve just stood up for myself and said, ya know, just because insulin is goin’ in (oPod) doesn’t mean I need more glucose! but anyway, I didn’t care to fight it at that moment)
The only thing I would tell (everyone if you want to be the most sure) who would test your BG is to prick your finger on the side of the finger pad, NOT the middle (I guess unless you poke your fingers right in the middle…OUCH!) I talked to the nurse anesthetists/anesthesiologist beforehand and just said, “if you’re going to poke me do it here (side of finger indicated)”… they said “oh, I’ve never heard of pricking a finger there…” SERIOUSLY! who teaches these people! (i’m just kidding. i was glad i could teach them something)
Cynthia,
That is horrible. You must still be in shock. I don’t know what that doctor was thinking unless your friend had something else going on that we don’t know about. But you are going to be fine!! I’m picturing you having your surgery and going home–no complications.
That’s the crazy thing. When I went to school to become a nurse they were just starting to use the blood glucose testing strips. And I remember pricking right in the middle of the finger. I feel sorry for my patients now. Cuz that hurts!!
I had open heart surgery last year, with some additional procedures, and I made sure I told the anesthesologist about me being diabetic. I had no ptorlbems, in fact my diabetes was almost too well controlled! Best of luch with your surgery!!
I broke my ankle 5 years ago and had surgery to put in one plate and 3 pins. It was my understanding that the anesthesiologist was in charge of blood sugar management. But do share your concerns with everybody - nurses, surgeon, etc. After all, you are a medical consumer and have the right to optimal care.
Post-surgery, it is important to do everything they tell you with regards to elevation, not putting any weight on it, etc. I don’t know if you will be in a boot or a cast. I was in a boot and every day had to carefuly remove my leg from it to inspect the incision sites for infection, and also to do a few little toe wiggling exercises.
When I was done healing, the surgeon said he knew I had followed his instructions because it went so smoothly. Then he also added “I’m pretty surprised, because we know that diabetics are notorious for not taking care of themselves…”
Ewwwwww! I hate that characterization of diabetics!I had someone on a gateway board tell me that I was the first diabetic she’d known who took care of themselves. I immediately gave her this website!
I had foot surgery and instead of putting me under they put me under long enough to give me a nerve block in my ankle so that I would be awake and I could communicate if I felt low or high. Also talk to the anesthialogist about what his practice is with diabetics. I make sure I talk to them before hand and communicate with them about my blood sugar as well as how to run my pump. I got lucky and one of his nurses was actually on the same pump as me and he assigned him to my case so there was someone there that could help out.
I had a hip replacement several years ago. I told all the people that I came in contact with the morning of my surgery that I was a T-1. My doc did have me cut my overnite dose in half the nite before. But I did find out after my surgery that the nurses prefer to have diabetics stay higher than we would like. They don’t want to deal with lows. I said that was unacceptable to me. I also did all of my finger sticks with my own meter which I kept near my bed all the time. Hopefully you will not have to stay in the hospital very long, or at all. I have learned that most nurses have no clue how to handle adult T-1’s. They mostly deal with T-2’s, not that they should be handled any differently.
Anesthesiologists test BGs during surgery. There is nothing wrong with writing a nice note reminder. They will not think you are a control freak.
Tell them you’ve been having surprise lows. The number of times they do the BG depends on what you have told them your long term insulin does over the time period you’re having surgery. If you have it set so your BG does not change and you have told them that, they’ll check it out for themselves anyhow. If you’re having surgery for 2 1/2 hours, I would guess they will have done 3-4 tests during that time. If there is any difference between what you have told them and what they get the first time, you can be sure they are going to do some re-runs.
The normal is that they have some 5% glucose hung in a bottle, and they will or will not use it according to need. What they have done is kept patients’ BG higher than normal in order to not experience a drop at a time when they’re busy with something else. They may do that with you since you have these surprise lows. Be very honest with them.
Lastly, in the post-anesthesia recovery room, after you’re awake, ask for your tester or ask a nurse for a tester and test yourself. My experience is that they want to give OJ, and it is always too much, especially if you have been given any 5% glucose IV.
Best wishes for that ankle.
I had lumbar surgery surgery January of 2008. I have allergies with anesthesia so very minimal was given. My pain nerve was blocked instead by the anesthesiologist.
My blood sugar level was taken during the pre-operation procedure. During the pre-operation briefing, where all the concerned doctors were there (My endo, the orthopedic surgeon, the anesthesiologist, a couple of interns, head nurse, my Mom and my husband) all my stats were given, a brief summary of the procedure was given, all medications was also disclosed and other existing concerns were also discussed…that I am a diabetic and asthmatic. These information given to everybody during the briefing was a relief for me. At the intensive care, my blood sugar was taken and monitored every 30 minutes.
