I'm undergoing surgery for the first time within a week, and am wondering what people have done for surgeries before? I have an insulin pump and sensor, and would like to stay connected to both. Do I have control over that? Should I leave the sensor on while I'm under? I haven't had the best experience with the doctors managing diabetes during a recent hospital stay, so I'm more than hesitant to relinquish care to someone else.
I had surgery to fix an umbilical hernia last year. While it involved what was supposed to be a "small incision" that turned into a 4" cut when "we found something so we had to change the plan...", I was able to keep the CGM going and pump going as long as I arranged to have it out of the way, although it was wierd w/ the pump and not having any clothes on as I'm sort of hooked on having it hooked to my clothes. The doc didn't totally impress me when he said "what's that?" looking at my CGM but he was useful and seems to have done ok. It didn't totally suprise me that they ran into stuff as it had been a bit bothersome for a while. I was apprehensive beforehand and ran up a shade to 130 something, which alarmed the admitting nurse a bit but I'd just taken a cut correction bolus. I think it was 2-3 hours and then recovery or something and I woke up at 3:00 and was fine but the anesthesia made food taste GROSS so, despite being hungry, it was awkward eating.
The anesthesiologist asked me if I loved my pump and agreed they are "awesome". The last thing the ER nurse told me before I passed out was "walk. It will help your recovery" so I did that, although that wouldn't help too much if you have your knee done or something? It worked out ok. I made it back to work on Tuesday after getting it done Friday although I didn't run for like 3.5 weeks and didn't start lifting again for 6 weeks, at quite a bit less weight than I'd lifted before. It seems to be in pretty good shape now, no complications, diabetes or otherwise related?
Is it outpatient surgery, or a hospital stay ?
If outpatient you shouldn't have problems, and they will likely let you keep the pump and sensor as long as it doesn't interfere with the surgery. I recently had outpatient surgery, and used a travel/security waist pouch to secure my pump/CGM. Be sure to have your infusion site and sensor located where it won't interfere. There is usually a nurse or other staff that you should talk to prior to surgery to discuss this with. They will ask about all your medications, as sometimes they request you to stop some the night or day before.
Most places want to schedule diabetics first thing and might tell you to talk to your endo regarding managing your insulin. Some will say to take 1/2 their normal am basal. With a pump you have more options. I used a temp basal, and ran a bit high, similar to AR, to reduce the chance of a low.
You definitely want to let them know if alarms might go off, and what to do about them. I told them to ignore them, and I turned off the ones that I could.
If you're going into the hospital, it's a different story. I haven't had to deal with that, but there have been other posts discussing that and suggestions on getting 'permission' to manage your own insulin. For example, if you're on an iv with dextrose, you'll want to know about it !
I would definitely have a plan with the physicians that are involved in your care. I am a nurse and am constantly amazed at how little healthcare providers actually know about Type 1 and all the technology that can go with it, like pumps and cgm's. Sometimes you have to insist on the amount of control that you need or have specific instructions in place, for example, when I had surgery, while I was awake and coherent I was the only one to ever touch my pump, if I was in recovery and wasn't quite awake and needed a correction my husband would be the one to manage my pump. You know way more about diabetes and your body than anyone, and what most people don't realize is that you, the patient, has the final say over your care. A physician or nurse cannot force you or make you do something that you don't believe is the correct thing to do or something you don't wan't to do. They are supposed to be partners with us in our care!
I have never had a nurse or surgeon have an issue with me managing my diabetes in the hospital or for surgery, in fact, most seem relieved to allow me to do so and I think it's because of their lack of understanding and knowledge.
i had an out patient surgery a few years ago and was able to stay on my pump. but if you are going to stay in the hospital for recovery they often prefer to remove the pump and administer insulin. talk to your surgeon or surgery team about your options.
I had major inpatient surgery last year at a big NYC hospital and was very unhappy with how they managed my blood sugars after surgery.
At the time I was on MDI, and per my endo's recommendation, cut back the Lantus 20% before the surgery as I would not be eating for awhile.
After the surgery, the nurses managed my blood sugar using *regular* insulin, subq, on a *sliding scale*. Ancient crap. The blood sugars were between 200 and 250! Unacceptable!
The day of surgery I was too zonked out on pain killers to manage things effectively myself. The next day I starting mumbling to the doctor about my dissatisfaction with the blood sugar control. His answer was "we need to get you out of here as soon as possible and then you can go back to your normal regimen." The thrid day I started telling him I was worried about DKA with these high numbers (well it really wasn't imminent, but I thought I would scare him). It worked...next thing I know the nurses came in with Lantus and Novolog. I was released late the third day and took back control.
The *right* way to do this, IMHO, for a type 1 is to (a) ensure that there is an in-house endo brought in on consult to manage your BG (b) they manage the BG with simultaneous , titrated IVs of human insulin and dextrose solution, adjusting the flow rates of the two to hold you flat at normal levels (80-100). Regular insulin IV acts *instantly* just as it does in your body, as opposed to when it is injected subcutaneously. If your gonna have an IV anyway, might as well use it to get tight control of the BG.
(c) Go back to self management as soon as you can (i.e. you are awake and feel well enough to control it with a clear head without making mistakes).
The hospital personnel and most doctors are astonishingly ignorant of T1 and the modern ways and technology of managing it.
Make sure the anesthesiologist knows about your diabetes as he/she will be managing your BG *during* the surgery.
For short outpatient procedures, it may be sufficient just to cut back your basal somewhat. Ask your endo ahead of time what they recommend.
If this weren't a special case (Sloan Kettering) I would go instead to the hospital my diabetes center is at and have their inpatient endo manage things.
I've had three surgeries while on my pump. I don't know if yours is outpatient or a stay over night, but mine were all outpatient. I have had no serious problems with my diabetes during any of these procedures. Make sure you specifically tell everyone you talk to that you have diabetes, especially the person scheduling your surgery because they will put you first or second in the line up so you don't have to fast for too long. I have always lowered my basal rate either the night before or the morning of depending on when I am scheduled to go into surgery. I do not however stay on my pump while I'm under. I would much rather run a little high than go low while under anesthesia. I just stay on the pump until the moment they come to sedate you then give it to whoever is with you. Make sure they don't give you a glucose IV drip either and that everyone you speak to knows they have to monitor it. After surgery connect back to your pump as soon as you're awake and check your BG. Also be aware of how much soda or juice you drink after you wake up. I'm not sure about the CGM because I don't actually wear one, but I would be surprised if they let you keep it on because you are not allowed to wear any metal or such for safety reasons and the mechanisms in the CGM might cause issues I'm not sure. Make sure to bring an outside meter just in case. I have had good experiences with all my surgeries so as long as you communicate with the attending people there shouldn't be any major issues,
Good Luck and Don't Stress :)
I just had robotic kidney surgery 2 weeks ago. My pump was on during the 3 1/2 procedure, and I talked in depth to my anesthesiologist prior to surgery, even showed him how to suspend my pump if needed. He assured me he would do frequent bs checks. When I got to recovery my blood sugar was 165, I was able to do correction bolus and all was well. Tell everyone involved with your care about your diabetes and pump. Be sure to ask your surgeon if x-ray will be used, I have an Animas pump and xray will damage it....I found this out after having a back fusion surgery 2 years ago and left my pump on. Had to get a replacement pump
after I was home a few weeks. Good luck!
I would definitely talk to the surgeon first, and I might even ask if it's possible to talk to the anesthesiologist who'll managing your surgery. I've had two awful experiences in hospitals with my pump. The first was when I was having bladder surgery (at a major Boston teaching hospital, no less) and the anesthesiologist told me that since I was on a pump, I'd have to manage my own blood sugars during surgery. HUH? Hello, Doc, I'm going to be UNCONSCIOUS!
Second time wasn't surgery, but was admitted due to a stroke, and the stupid hospitalist didn't know a darned thing about pumps and made me shut mine off...actually, what she caused was worse, because since I had aphasia and couldn't get my brain to communicate with my mouth or fingers, I totally messed up my settings and ended up having to stay off of it for four days until I could manage to reset it. My PCP was furious when he came in the morning after I was admitted and found out they'd taken me off the pump.
So, do whatever you can BEFORE you go in for surgery to ensure that everyone is on the same page with you.
Ruth
Whenever I've had any type of procedure such as cataract surgery I've always stayed hooked to my pump. What the dr. and his team would do would be to monitor and if I get low they would give me glucose. What I would do before going under I would set a higher temp basal because procedure would usually be early morning and that's when DP would kick in. I would let dr. know that I was giving myself more insulin.
It really depends on what type of surgery you are having. I have had several major operations while wearing my pump / CGM without any problems. The determining factor is going to be can you take charge of your BG soon enough after the operation to maintain BG control. I would agree with others and say never give up your pump if you can stay in control.
I'm currently recovering from a major organ transplant and there was no way for me to control my BG after the procedure and was kept in a induced comma for hours after the transplant while they did scans, Doppler imaging, and also gave me large doses of Predizone and other drugs to shutdown my immune system. They placed me on a novolog drip with glucose, at some point your body needs some sugar and staying alive becomes priority #1. After I was moved from ICU they took me off the insulin drip/glucose and started giving me massive doses of Lantus and added novolog when I started back on solid food. There was just no way for me to deal with a pump but my pump became the last big issue because they had no system to transition me back to my pump and go home. They agreed to let me start pumping and the nursing staff tested my BG every 4 hours and I had to prove I could control my BG without outside help.
Liver, right? (I remember from a former discussion) So glad to learn that you found a donor! Good luck, and I hope you are feeling better soon, that the transplant makes itself right at home, gets right to work! Major organ indeed.
I received my liver transplant on 7/23/12 and I'm home now although I go to the clinic almost everyday for blood tests and scans. I was Dx with HCC (liver cancer) in February and received a transplant July.......
I'm 12 days post transplant...;-)....even smiling hurts but life is good....
I'm recovering now from foot surgery I had last Thursday. I'm on the Omnipod and I checked with my endo before the surgery and she recommended that I keep my BS about 150-180 for the surgery. I was in as an outpatient so it wasn't long - about 45 minutes for the surgery. They scheduled me to be at the hospital at 6:00AM and I was home at 10:30AM!!