Are there any type 1’s here who have had to go under general anesthesia before? My daughter is 3 and she’s been a type 1 diabetic for over a year now, and they want to put her under for a small procedure. The doctors haven’t given me a lot of information, and they’re not taking my concerns very seriously. Can you tell me how they usually handle blood sugar in a situation like this one? Are there questions I should be asking them, or anything else that would be useful to know?
Thanks in advance 
I was under general for about an hour and a half last year for shoulder surgery. Make sure the anesthesiologist is aware of her condition- he or she is responsible for this facet of the surgery. Is she on a pump or injections? They will probably want her to reduce the basal insulin and run a little on the higher side. I think I stayed between 130 and 170 during the surgery. Stress hormones caused by the procedure can raise blood glucose levels during and after the surgery, so be mindful of that. By “small procedure”, do you mean “short”? If so, the anesthesiologist may not even test her blood glucose during the operation- mine didn’t. They would be able to spot hypoglycemia in any event.
When I’ve gone under, they usually test prior to going under and then they test every half hour or so during the procedure. I also remember them keeping me on sugar water to avoid a low and providing insulin if needed depending upon the length of the surgery. I did not have a pump at the time.
Don’t be afraid to ask any questions you have and have a clear understanding of what they plan to do. She is your daughter, you need to speak up for her. Remember… like anyone else you would ask services from… they work for you.
i have no idea. I went under while i was in the hospital, after being diagnosed (almost went into DKA)… So i guess everything went fine because i’m still here, they must have known what they were doing because i sure as heck can’t remember
Insist on being the first surgery of the day, that’s what I’ve done.
i went under for the removal of my wisdom teeth. i was on injections and i reduced my morning lantus by 50% so that i would run a little higher than normal (i was also the first appt. of the day). They also had an IV with sugar water in me just in case of hypoglycemia. It was about an 1 1/2 hour procedure. Everything went fine. Just be sure to let everyone around her know about her condition. They should know what to do in any event.
I have!
wisdom teeth, appedectomy/gallbladder, tonsillectomy and adenoids
request to be first so you don’t have to fast as long as Marie mentioned.
If your daughter is a pumper, you may want to decrease the basal - As for MDI you can also decrease the Lantus/Levemir
Same as others mentioned…
I was under general anesthesia for an appendectomy. I reduced my basal slightly (took less Lantus the night before). I think that they wanted to make sure that I was above 140 to prevent lows.
I’m not sure if it was a result of the surgery or the infection or both, but I had really high blood sugars the next fews days and had to increase my insulin dramatically.
Supposedly, when they were putting me under, I repeated over and over again: “I have type 1 diabetes. I have type 1 diabetes.” I wanted EVERYONE to know! Next time, I might just write it on my forehead!
I think that she will be fine, but you should ask their plan for testing her blood sugar and what should be done to prevent lows.
that’s actually not a bad idea to write “type1diabetic” with a Sharpie on your bod somewhere noticeable!
I have been under numerous times, the most radical being open heart surgery. As others have I suggest going in early and a little high. I tried ot land at the hospital at about 180 - 200. Given the fact that she will be under for a short while, you should have relatively few concerns. The Sharpie idea is a good one.
When she comes out, her BS will likely be elevated, and that is when you as a mom can really make a difference. I always instruct my wife to get a BS as soon as possible when I come out and treat appropriately. I want my BS to be in the low 100’s while staff will be content with a BS around 150. I think that getting it lower promotes healing in the first critical 24 hours. No offense to the nurses, but I am so concerned with infection and they often have mroe immediate issues, like blood loss, sutures, and bandages. I really want someone to watch over my BS.
Good Luck, but she will be fine.
Rick Phillips
When they were putting me under, I had to get a scaline block as to reduce the post-surgical pain, which for a distal clavicle resection is pretty excruciating. That meant they had to find the nerve at the bottom of my neck which relays the pain signals from the shoulder, and they could only do that if I was awake and reflexive. So, instead of discussing my diabetes right before I fell asleep, I was getting stabbed in the neck with a big needle over and over until my arm jumped from the needle hitting the nerve.
I kept repeating something, but it wasn’t anything to do with diabetes.
This seems obvious, but people do screw up. Be sure to check with the nurses about any IV’s she gets. A Type 1 friend was in the hospital & they gave him an IV with glucose.
The Sharpie idea is great!
Terrible that the doctors aren’t taking your concerns seriously. What’s routine for them isn’t routine for you & your daughter. Can you ask your daughter’s endo to consult with her surgeon?
I bet it wasn’t, I also kept saying stuff that I would rather keep to myself !
Yes, asking your endo to consult is a GREAT idea!
Also, perhaps you can get the endo to request that YOU manage her insulin after she comes out of the surgery.
When I came out of surgery, the nurses told me that I would have to start on regular insulin because that’s what they give to everyone. They even had a fixed amount that they give to everyone. I protested (literally kicking and screaming) until an endo came and wrote on my file that I should manage my own insulin.
If she will be hospitalized, then it would be a good idea to make sure that she can continue the same types of insulins that she uses now.
Why do they think that we cannot manage our own insulin if we have been D for years ?
I’ve gone under for 2 breast biopsies. The first time, it went pretty smoothly. The second was not as easy. My blood sugars were in the 300’s (I was on nph and regular 2x a day at the time, and was told not to take my am dose…). They tried to get it down at the hospital, but I guess the stress and my dawn phenom (which I didn’t know i had back then) made me pretty resistant. I ended up having to reschedule the surgery because my #'s were too risky. A week later, all went well.
Definitely talk to your daughter’s endo and get his/her recommendations. Find out what her targets should be pre and post op, and by all means see if you can be in charge of administering her insulin while she’s there. Make sure all involved in the procedure know she’s type 1, and as others have said before, see if she can be one of the first surgeries (that is usually the case with children, especially as young as your daughter.
Good luck. Let us know how everything went.
Kristin,
The friend I mentioned had the same experience. He’s been Type 1 for 33 years, yet the nurses gave him a hard time about his pump. His wife had to kick & scream for him
My niece will be undergoing spinal surgery for six hours. The anesthesiologist will start an insulin drip to manage her blood sugars, also they will have on hand a dextrose drip to raise blood sugar, if necessary. In her case, they will start the drip some time during the night before surgery. This is common and anesthesiologists know how to manage blood sugars in this fashion. As soon as she is out of the ICU they will determine when she will go off the drip and we will reconnect the pump. For a short procedure, I doubt if this would be necessary. For instance if the procedure lasts two hours, maybe they would disconnect the pump, give half the bolus upfront, I’m sure they must take BG during the procedure, and you can correct when she comes out of anes. Yes, you must ask questions. You must be notified as to how they are going to handle her BS during the procedure, talk to the anesthesiologist, ask how they will handle high and low blood sugars. Our anesthesiologist contacted our pedi endo for her recommendations after our first appointment with the surgeon.
Was this in the United States? I know in the US, you can refuse any treatment or medication. My reaction would have been similar. But when I had my surgery last year, they had me keep my pump attached and let me handle it as soon as I woke up.
Yep, was in US. They told him he wasn’t capable of handling his pump & it was safer for them to give him injections.