I am having surgery this week and am pretty panicked about going on Lantus and relying on others to keep my sugars stable. I am more concerned about that then about the surgery. I have several questions:
If I take 24 units of long acting insulin a day in my pump to cover my basels, how much Lantus should I take when I will be fasting for a while.
My usual endo says 24 but a hospital endo says 25.
If I have a low a few hours before surgery and can't eat or drink anything what do I do? Can I safely take gel or icing?
I will ask the hospital endo again, but would appreciate comments
If I take Lantus at 1pm, at what time the next day can I go on my pump?
....in 23 hrs or 24 hrs?
When I get anxious, everything I learned goes out of my head.
Thanks!!!
I'm surprised they won't let you stay on your pump.
I had several surgeries (one as recent as 6 weeks ago) where I was put completely under and every time I kept my pump connected. As a plus to the surgery team I had my CGM too which they felt every diabetic surgery patient should have during surgery as it gave them perfect trends of BG's instead of single numbers.
All you and your endo have to do is figure your basal rates to compensate for the no eating (and stress).
Of course you should talk with your educator or who you work with on your management team. That said, taking Lantus by shot and not in your pump is more typical. (Or did you mean rapid acting insulin in your pump for basals) The Lantus would replace your 24 hour total basal (that amount is typically not too much basal and sometimes not enough and can be found under basal review). Usually , reconnecting your pump between 22-24 hours from Lantus dose time is fine.(Lantus for sure doesn’t last longer than 24 hrs and often less and remember sugar management can often be more art than science! When you reconnect you can test more and 1-2 hours of basal/rapid insulin overlap wouldn’t be a huge issue).
If you get low glucose tabs/gel are typically fine (typically they just don’t want ‘anything’ in your stomach and tabs pretty much hit your blood and don’t hang around in your stomach).
If your basal rate in your pump is accurate you should be able to fast without lows or highs, but test more than usual)
I understand that you must disconnect during electrocauterization which will be part of the surgery. Don't have a CMG...great that you have it! Thanks....
Thanks so much! I will have gel at hand. I get flustered whenever there is change regarding my pump.
Seems strange that there can be such a range of time that the Lantus wears off. I try to be accurate but I should let go of that idea and be more flexible....22-24 hours is such a wide range! I'm having abdominal surgery and a lot of the areas I'm used to connecting my pump on will no longer be available to me. I've never connected on my arms or thighs before. Have you done that?
Just a quick point: if they want you to observe the strict “nothing by mouth” protocol, they can start your IV early and add a bolus of glucose directly to it if you start going low. Thats the easy way for them to maintain you. And of course, IV administration means the start of your response time is measured in tens of seconds instead of several minutes.
DO bring your CGM with you and set the alarms pessimistically (early). Everyone from intake to discharge will thank you for that. They may insist on taping it to you (wrists seem to work well), but the slight discomfort and tape mess is worth the peace of mind.
Final point: hospitals tend to make rules based on what works for 98 percent of the patients. They may have some policy against the patient having ANYTHING with them during surgery (rings, jewelry and piercings come to mind). Rather than trying to fight such a policy directly, talk to the nurses and explain to them this is a medical management device prescribed by your physician that will help keep you alive and make their job much easier and faster. Once they see the utility of having a CGM, they may decide the policy doesnt apply. (FWIW, nurses are usually overworked and under-supported. And the nurses are the first ones to get thrown under the bus if something bad happens, so they are often quick to see the value in having another monitoring tool at their disposal).
Yes I've done and do legs, arms and love handles in the back as my abdominal is to scared from 45 years of shots, pump, and CGM inserts.
Roark your final paragraph well said and from my experience well received as mentioned above they love the extra monitoring tools.
CGM more so than the pump but you as the pumper know a lot more of how your body reacts then most if not all of the surgical team.
Thanks...I'll have to start...
Wish I had one!!! I have to trust I'll be monitored carefully, but I am not easy with that...
In terms of monitoring, just have your endo sate in his orders that you must be stested every hour. Simeple as that, they have to follow MD's orders. And talk to your Endo about what they will have in your IV for hydration. As was mentioned above, they tend to use what works for 98% of the patients - but we aren't in that percentile. It's possible that the Endo will order saline instead of the "sugar-water" they usually use. THat should help with our management. My biggest worry is if I lose the argument to keep my pump and CGM they use R in the IV. All I can think of for a reason is that it is o much cheaper. Good luck and speedy recovery wishes your way.
Thank you artwoman...appreciate your suggestions