I’m currently on my ophthomology (eye doctor) rotation for 4 weeks. It’s an elective I’m doing because I’m seriously considering choosing it as a specialty.
So…today I’m sitting in on a surgeries all day…EYE surgeries. For those that have no experience with it, eye surgery (in particular the glaucoma and cataract surgeries I saw today) involve a lot of very precise movements under a microscope on a patient’s cornea (the clear part in the front of the eye), sclera (the white part around it), lens, and iris. These surgeries are performed with very small instruments that you can barely even see unless under a microscope. As I watched this extremely skilled surgeon perform this little “micromovements” I began wondering about hypoglycemia and surgery.
My thoughts ventured to the comment I left on Penny’s page yesterday, about making sure her son knew he could grow up to be anything he wanted. Yet here I was, watching a surgeon, wondering if I could safely perform the same procedures he could…doubting myself…scared of going hypo. In the end, this was really only a fleeting thought; I quickly convinced myself that these were short procedures, and careful control would likely get rid of any danger, as would a CGMS monitor should I choose to get one. But obviously, the thought stuck with me all day, as here I am writing this.
My question for you all is: knowing yourselves the feelings of hypoglycemia, and knowing that, as a diabetic, you could someday very well require just such an eye surgery (or a retinal surgery like it), would you trust a diabetic micro-surgeon? I’m pretty sure that I could handle it, but I’m still curious to hear your thoughts…
Interesting question, although I suspect I would never find out whether my eye doctor had diabetes or not. Also, its worth noting that the range of glycemic variability is generally larger in type 1 than it is in type 2. According to Dr. Zack Bloomgarden, who is noted not only for his huge clinical practice (more than 1,000 patients) on New York’s Upper East Side but also for his many articles on diabetes (nearly 250), type 1 diabetes is a hugely different burden from type 2 diabetes, and he says the easiest way to quantitatively understand that is to have a thousand patients or so with diabetes that you treat for years and download their meters day after day after day – when you do that, you’ll find that the standard deviation of the blood sugars in a person with type 2 diabetes is 10 mg/dl or 20 or at most 30 or so. The standard deviation of the blood sugar of someone with type 1 diabetes is at least 50 or 60 and often 90 to 100. So that translates into just huge, huge variability in blood sugars.
From that perspective, then, I could have concern about a doctor with type 1, but probably not with type 2, and even in the case of a doc with type 1, my concerns aren’t huge. Many patients with type 1 can attain great stability with an insulin pump that can vary their basal rates accordingly throughout the day. My own basal rates are less than 0.02/units per hour (close to nothing), but I still have issues with insulin analogs and may ultimately return to regular in my desire to reduce the variability I see. But a lot will depend on the doctor themselves, but that has little to do with their condition. I would be as concerned about a doctor who has heart problems (what if he/she has a heart attack or stroke while in surgery?), or vision issues (cataracts, severe myopia, etc.) so I don’t think diabetes is necessarily going to disqualify someone … there are many variables to consider, and this is only one.
Y’know I think a doctor’s physical condition is just as important as their mental status - and to be honest I’ve been far more concerned about the sanity or stress levels of my physicians than I have been about their physical health. How many doctors have I consulted with who were so distracted they could barely stand to have me ask them questions? I would HOPE they’d have more focus during a surgery, but I’m not 100% certain they wouldn’t be thinking of 5000 other things at the same time.
Would I want a Type I doing a delicate surgery on me? I don’t know - depends on the given day, hour, minute, second. You know how it is. 80 to 180 in 30 minutes. 263 to 54 in an hour. Or a whole day at a cool 95 (awe-sommme). I agree with Scott that there are a myriad of physical conditions that would freak me out a little, but in general I’ll give the doc the benefit of the doubt because it’s what I’ve got to work with.
Maybe I’m just biased because my gynecologist only has one eye and two hearing aids and has been practicing since approximately 1872.
I have serious doubts about letting a type 1 touch my eyes. I know first hand what a hypo type 1 can do with a power grinder. I really have trouble accepting one weilding a vacuum cutter. It’s not so much a concern at your age. It’s more a concern when your 35+ and experiencing hypo insensitivity. CGMS are not perfect. Eye surgery demands perfection.
My answer may be a little biased since I’m a type I, but I think a good ophthalmologist who is a diabetic would make sure their levels are in check before beginning any surgery. I would also hope that if they experience hypoglycemia unawareness, that they would either have a CGM or check their sugar right before surgery. I don’t think that a doctor should have to disclose that they have diabetes either as long as long as the patient isn’t at risk.