:Unexplained catastrophic hypoglycemic episodes following knee replacement surgery

After having total knee replacement surgery less than two weeks ago, I was placed on oxycodone and oxycontin for pain and coumadin to avoid clotting. I am dropping below 70 mg bg on a regular basis, even if I give myself a temp basal of 0% most of the day. I am unable to do physical therapy, because that aggravates the hypoglycemia. I have no idea what to do. I am spending half the day and night eating sugar cookies and drinking orange juice. I have also been eating extra protein. No luck. I have researched the medications I have been placed on post op and find no guidance on line. Does anyone have any ideas about what I can do to avoid the catastrophic lows I am experiencing?

What do your boluses look like? Are your hypos at time after a meal? It just seems odd that as a type 1 you would suddenly have no need for a basal.

If previous to your surgery, you had been particulary inflammed or in pain, that can cause elevated blood sugars. It might be possible that your body is now relieved of the inflammation and you just need to reset your basal levels.

Hi, my daughter Sam just had thumb surgery & had weird lows following it. She was taking Percoset. I googled it, and info said Vicodin & Percoset can cause low blood sugar. Not really sure if this was the case or the drops were from the stress & pain. But she didn’t have those drops to 35 after she stopped the pain pills.

Thanks for you insight. I am running low after meals and boluses.

It may be a good time to examine whether your insulin needs have changed.

I suggest adjusting your correction and insulin to carb ratios so that your correction and meal bolus amounts are lower. Maybe start such that your correction and meals bolus insulin amounts are a third less.

I had at total knee replacement about 9 months ago and had similar issues during recovery. I really didn’t take the pain medication for very long – I found I preferred extra strength tylenol but I still had problems with hypos. I think much of that has to do with the pain level and the intense energy it takes in the early stages of rehabilitation – PT is a bear. I had to experiment at bit – but I ended up dropping my basal by a cut both my basal and bolus by 50%. I checked a my bg a lot more regularly but I found that I really didn’t run high with these adjustments other than an occasional correction a couple hours after a meal. You’ll ultimately find your way back to your typical doses. Just test test test and test again during this time.

I presume you had a general anaesthetic (and probably a whole cocktail of drugs while you were asleep!) and GAs can cause some unsettled readings for some time, along with other drugs.

Get together with your endo or diabetic nurse as soon as possible. I suspect that you will need a bit less insulin and more carbohydrates in your food, such as rice, potatoes, pasta etc. I do not know if you are low carb, but if lows are your problem perhaps now is not the time to be going down that route.

Also you do not say if you are still in hospital and on IV insulin! Nurses are notorious (at least in the 3 hospitals I have been in) for setting that way too high and then not being able to get my sugar levels up. Now I insist that while I am conscious I will do my own diabetes management and keep snacks at my bed side - and generally cause a bit of a stink if I do not get fed regularly. I have found that I am highly sensitive to human insulins and am now on pork insulin which suits me better, but they will not consider doing that IV! They think they know better, but really they do not. You and I know our bodies far better than any medic!