Levemir, Insulin during surgery, misc

Found this great board a few months ago, then became really busy, went away, and returned home to get my kids’ chronic medical conditions straightened out. So I’ve hardly had any time to be here. Just wanted to mention a few things that I found interesting.

Over the past two months, my daughter has had two procedures that required being asleep and two surgeries. For the first two procedures and the first surgery (under for about an hour), Katherine woke up with the same exact bg number she had before falling asleep. For the other surgery (under for about 2 hours), her bg only went up 10 points. I really thought she’d be fighting highs b/c of nerves, or lows b/c of anasthesia. That really surprised me.

The other thing that surprised me was that NONE of the medical professionals ever heard of Levemir. Yes, it’s relatively new, but it has been around for a few years now.

Something else: I have been paying attention for years to others’ experiences with surgery, as it is true that most medical professional don’t have a clue as to what to do with a T1 during surgery (the anasthesiologist’s job). They have a better idea, but most wanted Katherine to cut her morning Levemir dose in half (she gets 28 u), and one wanted to eliminate it completely! Glad I checked with the endo beforehand, though, b/c she said to reduce the morning Levemir by no more than 20%. Also, a nurse referred to Katherine as a “brittle diabetic” b/c of the amount of insulin she was on, and was surprised to hear that Katherine’s A1c’s are in the 6’s. And this nurse was a T1 herself! I explained that Katherine’s endo has explained to us that 13 is a tough age for T1s b/c of all the hormones, and that no, she was not “uncontrolled” - the word that nurse used to describe anyone who’s on a larger dose of insulin. But for the most part, they were good experiences. I was expecting a lot worse, but all were pretty cooperative about watching her bg while she was under.

Jeannie, it doesn’t surprise me that Katherine stayed stable during her procedures with Levemir. When I had stuff done, I did not cut back any because I knew from basal testing, I would not go low. When I had cataract surgery, I also took some Apidra that morning because my BS was going up between stress & DP. The nurses freaked when they heard I took any insulin.

The nurse surprises me! More so that she is a T1 and actually thought that. She should know better. I wouldn’t be afraid to bet that Katherine’s A1cs are better than the nurses. Volume of insulin shouldn’t have anything to do with someone’s control – there are insulin resistant people with good control.

I get the never heard of those a lot also between Levemir & Apidra.

How much insulin your daughter takes has nothing to do with control. When I was a teen, I required way more insulin than I do now. I later found out that the hormonal surges during the teenage years often cause insulin resistance. For me, this resistance went away when I finished puberty, and my TDD went down almost by half by the time I got to my 20s (partially due to getting through puberty and also because I was eating fewer carbs and exercising more). I think the teens are the worst time for T1s…you just gotta get through it.

Oh, it frustrates me so much when doctors and nurses who know nothing reckon that they know it all! Even one with Type 1 themselves does not know everything or indeed anything about diabetes! We are all different and have different experiences of the same condition and nobody should force you to do anything!

I myself have had a couple of operations and the doctors and nurses insisted that I have IV Levemir - and I am allergic to the stuff! Consequences are guaranteed to be hypoing 7 - 8 times a day - and badly, where they cannot get my sugars up! I am on pork insulin which is far smoother for me and far more suitable! And then I have had the accusation that I have been injecting extra insulin to bring about these hypos and seek attention! Nothing could be further from the truth!

There is a group in the UK who campaign for patient choice! I swear they saved my life when they worked with me for several years to fight to get onto pork insulin. They have now produced a “hospital care passport” whereby the patient fills in a document and details their treatment requirements, including food times etc. You can make a statement that says that you wish to be allowed to treat your own diabetes according to your own requirements, refuse the IV insulin.

I wonder if they have this document on line that you can download and print. I will look into it again and get back to you.

Meanwhile I hope your daughter (who has the same name as me!) soon recovers from her surgeries and will not require any more!

I have a friend with a pre-teen daughter who is not only on MORE insulin than I use, but she also tends to have better #'s than me (and mine are not bad) - I wouldn’t for a moment consider her “uncontrolled” based on her doses! She just has a mom and endo team that are really on top of things… they do an amazing job :slight_smile:

I too am shocked that T1 nurse would make those associations, however I have to say that my own nurse mother relates “testing often” to being “out of control” and doesn’t understand at all that T1 is a very fluid disease that requires constant monitoring to maintain good control - in her mind once you’re “under control” you should be able to STOP testing so much, but it doesn’t work that way - not testing is what leads to being uncontrolled! I’ve given up on trying to convince her otherwise… she hasn’t caught on in 10+ years and I doubt she ever will ever fully believe me.

LOL, I know a lot of people with that reaction. I laugh (and it is certainly not funny) because they assume I don’t know what I’m talking about. People, whether medical professionals or not, have grown up thinking sugar is prohibited for T1s, testing 3X/day is adequate, and if you didn’t eat so much “bad” food, you wouldn’t have T1! (If only that were true…) It’s hard enough to change peoples’ mindset, and almost impossible to influence their hardwiring and life-long beliefs in any way.

Whoa, IV Levemir! Levemir is forgiving, but I don’t know that it’s THAT forgiving! The hospital passport is a great idea - and the medical professionals involved should have to sign or stamp it to show that they read it, just like we have to sign papers every time we sneeze in the hospital.

Thank you-I think Katherine’s surgeries are over, and she is bouncing back really well.

I am glad to know that Katherine did well. I’m about to have surgery to remove a badly swollen salivary gland with a stone in it in a week, and Katherine’s experience gives me hope that I will get through it OK, too! :slight_smile:

Jeannie, Katherine did exactly the way you’re supposed to: wake up with the same BG number. Sometimes I wonder if there are Board Certified anesthesiologists in the rest of the country when I read these experiences with surgery and the ideas that are expressed by medical professionals… Anesthesiologists might not have heard of Levemir. Their type of continuing education deals with the poisons of anesthesia, code protocols, and waking people up. But they do know that a person in good control can take their long-acting basal insulin at their usual time. They know that if a person says their BG will not go low, they do not have to worry. Nonetheless, they put in the IV as they do with all patients, and they test at intervals for BG. They are the worriers of the crowd.
Unfortunately, nurses have had little teaching about diabetes because most were educated prior to patients taking charge with testers, CGM and pumps. (And in the spirit of full disclosure, I was part of the teaching force.) Continuing education that speaks about more than hypoglycemia and complications and that provides information about carb counting, basals, boluses, I:C ratios and insulin resistance and sensitivity is needed by every nurse in the US.

Good luck with your surgery Natalie. I had a swollen salivary gland once (for three days) and it was so annoying.

Thanks for your good wishes, Jeannie! :slight_smile:

This one has periodically gotten swollen, and itchy but not painful for 38 years. I’ve always been able to massage it back down. However, this year, it has been infected 3 times, and is extremely painful, and the ENT guy took one look at it and said it has to come out. I’m planning to decrease my basal by 0.1u per hour in order to run a little high – not really afraid of lows, but prevention is better than cure, eh? It HAS been a nuisance for a long time, so in a way, I’m glad to be having it out, but surgery is a bit scary, nonetheless.