I am a T1 on a pump and have no endo right now because she left practice due to disagreement with hospital admin. Just my luck I now need to have surgery. Hospital is concerned I don't have an endo to tell them how to handle the pump. They call my surgeon to see if he can get instructions how to handle this by calling my family doctor. Family doctor tells him that I need to disconnect from the pump two hours before the surgery and stay disconnected for 24 hours. There are no instructions about giving me any insulin during this time. The surgery is supposed to be out patient and only take 30 minutes. If something was to go wrong and they need to keep me in the hospital how bad will this get for me?
If you are having out-patient surgery taking 30 minutes there is no reason in the world for you to disconnect your pump at all, let alone for 26 hours! That is crazy! I would negotiate that you keep your pump and be tested before after and during if necessary. They are just trying to cover their butts at your expense imho.
I agree with Zoe but would add that being without insulin for 26 hours can be extraordinarily dangerous if you have no residual insulin production. If the hospital insists on disconnecting you, I suggest taking a break from the pump for a couple of days and go back to shots until after you escape from their clutches. Having basal on board will at least keep you safe.
Maurie
I agree with what your saying. I just made an appointment with a new endo but that is not until after surgery. I will be calling him in the morning to see if he can help me out. I feel like they are wanting me to go in a coma so they can make more money off of me. My family doctor hasn't had anything to do with my D treatment in over 3 years since I was DX as a T1. The endo I picked this time is also a T1. I think this will work better for me.
I have no basal insulin to give myself. All I have is Novolog and just a few needles.
I have a CGM and a pump. After the bad experience I recently had with ear surgery and the anesthesiologist not knowing how steroids were going to affect my BG, we've agreed that for the other ear (which will be done in 3-6 months) they will monitor my cgm and apply correction via the Omnipod controller. Since they can just enter the BG value and let the controller take care of IOB accounting, this is a great solution.
Of course, it depends on some confidence in the CGM readings to do this. I know well how/when my G$ is scary accurate, and when to be less trusting in the numbers.
In any case, I think that continuous BG monitoring and active insulin administration during surgery needs to be bought in the picture as a standard protocol for diabetics during surgery. We have the technology to do much better than "nothing", which is what we do today.
Your experience clearly reflects an irrational hypo-phobic legal-defense mindset that is all too common in medicine. If it were me, I would practice a few simulations during the week before surgery. I would try injecting one half of the missing one hour's basal insulin before disconnecting. Then reconnect one hour later and give the rest of the missing basal. Log everything and see what happens.
I would not, however, disconnect two hours before surgery. Instead I would disconnect as late as possible before the procedure. Then I would reconnect as soon as possible after the surgery. You may need to get the support and help of a willing friend or family member. Make sure you have a fingerstick meter, plenty of strips, and a source of fast-acting glucose on hand.
Good luck.
I agree w Zoe, no need to disconnect from the pump. every time I've had outpatient surgery, I've kept my pump with me. here is a discussion we had on the subject
https://forum.tudiabetes.org/topics/surgery-and-type-1
please talk to the surgeon and/or the anesthesiologist.
No CGM. Had one couldn't trust it.
Glad you said extra test strips because as I was packing up stuff I forgot these. I never go without my meter. They are going to have to make me disconnect the pump. When I was talking to admitting she said they get very few people with insulin pumps and this is probably why they don't take time and money to train there people.
I've kept my pump on for 2x surgeries. Both anesthesiologists were very pleased that it was there. I tested BG right afterwards both times and was where I wanted to be. Even when you're sort of half-baked after you come out of it and are being filled with narcotics, I was plenty rational enough to think "ok, my BG is ____, I need to ____" although I have quite a bit of experience evaluating my BG when I've been partying too. I don't see disconnecting as being smart. Elevated BG might compromise your recovery, depending on what you're having done. I hope you find some way to get some sound advice. Maybe fire the GP and get a newer, younger one?
Perhaps you can have a friend or family member hold onto your pump so that you control when it gets reconnected.
See if your primary will give you a scrip for some Lantus or Levemir pens. You should always have some back up basal around in case of pump failure.
When I went on a pump a little more than a year ago, my endo gave me 2 pens. One levemir and one novolog. She said I should always have a back up plan. I have had to use the novolog pen to correct for a failed pod but I still have the levemir pen unopened in the fridge. It's comforting to know it's there should I need to take a pump vacation. If the surgery is emergent in nature then I would say get it done. If not - I would wait until you have an endo with half a brain to give you proper counsel. I would not disconnect any sooner than you absolutely have to.
Wife will keep pump for me.
Thanks for the thread
I don't think they care about my recovery; they just care about there liability. But I will talk to the anesthesiologist.
Not having an endo right now what is causing the issue. Ready to get the surgery done so I can get back to exercising.
You don't give up your rights just because you are patient. You can give the hospital and surgeon instructions that you wish to remain connected to your pump and that healthcare personnel are not allowed to intervene with your blood sugar control. If you are going to be sedated for 30 minutes you can agree to suspend your pump for the duration of the procedure. But there is absolutely no reason for you to stop controlling your blood sugar. If you believe there is a risk that you will be unable to operate your pump then you can select a trusted agent to take care of that. You don't need that to be an endo or a doctor. I think it is insulting to be treated like a wild dog just because you have diabetes. What kind of person would suddenly become totally incompetent just because they have some outpatient surgery?
I have had a couple of procedures. I created a quick reference card--very simple--about handling the pump. This one was for my MiniMed. I was an adult educator for a long time and the format works.
IF the doctor is willing to use it. The one time I had a problem while under was at the dentist. He actually used it, although it freaked him out.
For 30 minutes, I would never follow those directions. Maybe you need a new surgeon?
564-EMERGENCYPUMPINSTRUCTIONS.docx (99.1 KB)