Hi all. It has been awhile since I have been here. I am in good management of the diabetes. I have a new concern. I may have to opt for knee surgery due to arthritis.
Has anyone had any kind of surgery and how did you do?
I worry about a few things:
Thanks,
Cathy
Hi @HopeFloats2020 ! I’ve had a few minor surgeries. Last December I had my wisdom teeth removed. I wanted to be fully staffed but they put they put in twilight sleep which relaxed me but I was awake. My numbers were lower than I wanted when I went in and they wanted them at a certain level before starting so they gave me IV glucose and I was high the rest of the day - the oral surgeon said he would rather I not bolus to cover it and I complied although I could have/should have pushed. But things are straight by the next day.
When I had my cataract surgeries I was told not to take my Omnipod controller/CGM receiver in with me, so insulin was flowing but would not adjust if needed. The procedures we short and no harm done. I had some selling in both retinas afterwards - the first to about six months to heal and I’ve reached that point with the second and it’s still healing. They say healing (retinal and otherwise) and take longer for us but it is improving.
Of course I was awake for those. I think I’ve only had one procedure under general anesthesia. This was about 20 years ago. I had gotten clearance from my endo but as they were about to wheel me in and out me under I started giving instructing on what my CGM was and what to do itf it alarmed - only to be told they could not take instruction from me - only me endo! I could reschedule if I wished, but at that point I was ready to go, so I did.
I could have/should have been more assertive in some of those instances, and while that last event was maddening it was silly of me to think I could give someone the “quick start” version of a complex medical device in just a couple of minutes. So: in discussions with your surgeon and anesthesiologist before you are scheduled, let them know about your devices and your needs and preferences about managing them. I don’t knew if you might ne u thro clear that with your endo - medical professionals like to keep things “in the family.”
I had my oral and vision procedures done at the hospital where my endo is on staff, so if anything happened she was a phone call and a few floors away - thankfully there was no need.
I have never had issues with healing so with that and other procedures ask want well - they did give me antibiotics to take which I think is standard with or without diabetes. Expect to fast starting at midnight prior to your procedure date - maybe even before - so make sure your basal settings are good and get some instructions on what to use if you do go low while you’re waiting. I try to schedule my procedures for first thing in the morning to lessen the amount of time for nerves to affect my numbers. Don’t be surprised if you go high afterwards - your body has just undergone a “medical assault” so don’t get worked up as you work too get them down - I hope that makes sense.
Wishing you all the best and I hope your surgery eases things for you!
@wadawabbit. Dorie, THANKS SO MUCH for sharing your detailed stories!!
I will make notes of them all.
Glad all is well.
Cathy
@HopeFloats2020 I use both Omnipod Dash pump, Dexcom G6 CGM, and my iPhone with Loop to control it all. I had kidney surgery recently under general anesthesia with a night in the hospital, shockwave lithotripsy (sound waves) to break up a kidney stone prior to that as outpatient under “twilight” anesthesia (I was out cold), and a colonoscopy before that with similar “twilight” anesthesia. The main problem I had was finding the right person to talk with; I’ve learned the default is at least two-fold: 1) the anesthetist and 2) the facility used. In actuality, I recommend several steps:
My reasons: For the colonoscopy, though I tried, I couldn’t find the right person; everyone just delayed up to the pre-medication procedure; I finally told the nurse to get me the anesthetist or I was getting dressed and leaving. The anesthetist came in, was glad to use my CGM, pump, and Loop app to monitor BG and control insulin dosing (he had previous experience with them, most will not. Ensure if they agree to unlock your phone, turn off auto-lock, or provide the needed codes. I don’t like getting surprised by being told to take devices off, want to ensure the doctor/staff understand the need (my/your life may depend on it) and NOT rely on his/her 20+ year old training. Nor am I accepting of facility protocols that are outdated, allow/want a BG in the 2-300’s, etc. Also, in the latest kidney operation, even though I’d discussed my T1 status with the surgeon, he used/provided a “standard” after surgery order stipulating a dextrose drip; I was awake enough to to talk with the day shift nurse who listened to me, read my instruction sheet (I asked it be put in my chart), and understood my need to avoid dextrose, and she hung a saline drip; the night nurse refused, hung a dextrose drip, refused my guidance for six hours+ until I told her I’d rip the @&#* thing out. The dextrose drove my BG to 220+ despite my pump trying its hardest to fight it along with me applying 3 corrections before discovering the cause.
I don’t say these things to scare you or anyone else, but if it had not been for my actions and use of Loop as an AID with my pump and CGM during my recent kidney surgery, I have no doubt my BG would have been in the 400’s with a real risk of DKA…all caused by the medical community’s mis-applied and mis-informed standard practices without an adequate understanding of a T1’s needs. The hospital and doctor involved have good reputations and histories; the hospital investigated and assure’s me they’ve taken needed action. My take: I am my own advocate, you need to be too.
Welcome back Cathy @HopeFloats2020, I’ve had several surgeries including orthopedic and also with cortisone shot. Yes, my BGL did go up and to keep me in my usual range more insulin was required. I had anticipated this would happen and had in place and ready to activate a “Surgery Profile” on my t-Slim.
I’ve always kept my pump active and delivering insulin throughout surgery, and in recent years the CIQ algorithm has done wonders. I have taken time before surgery to inform and provide instructions to anesthesia teams the meaning of the alerts / alarms. I suggest that a few days before surgery that you validate pump settings by skipping breakfast [assuming morning surgery] and make any necessary basal adjustments to maintain you at your desired BGL; keep in mind that basal rated 5 hour previous still have affect on BG.
Infection? What is your history? Remember that just because you have autoimmune diabetes does not mean you have a weakened immune system; immune system and autoimmune system, although sounding alike, are two entirely different things. Fortunately, I never incurred infection during or following my dozen open-cut surgeries.
Delayed healing; for me, very much just the opposite. Following Contracture surgery on my left hand the surgeon said she never had a patient heal as fast as I healed.
I hope everything works out well for you, just plan ahead.
I’ve had 2 surgeries under general anesthesia. Make absolutely sure you talk to the doctor performing surgery and that they write it in you chart that you are allowed to bring and use your own medication (insulin, pump, CGM, and test supplies) and that you are fully in charge of your blood sugar. 2 doctors at 2 different facilities and neither one had a problem with this agreement.
You might have to negotiate with your surgery blood sugar, my doctor asked for 180.
Good luck.
Hi @Dennis ! Always good to hear your experiences.
I don’t have a pump; don’t have a need or desire at this time.
Sounds ideal to have, though, for something such as surgery.
I will definitely get all the ducks in a row if/when I opt for knee surgery!
I’ve had all four wisdom teeth out at once. I’ve been under general anesthesia for an endoscopy. I’ve been under for hours while they took out my tonsils, uvula, soft palate, and anything else they could safely remove.
All of this was before I had a CGM or pump. I made a plan with my endocrinologist to make sure my blood sugar wouldn’t go low. Which mostly involved taking less insulin, since anesthesia is usually given on an empty stomach. I made sure that the surgical team knew I was diabetic, but they’d had plenty of diabetic patients before and there were no problems.
I was given prophylactic antibiotics to ward off infection. That protocol may have changed in more recent years. But they did the same for my diabetic grandfather. I didn’t have any trouble healing up.
Honestly, the hardest part of all three of those was that they involved my mouth and throat, which meant no solid food during recovery. Living off milkshakes for a couple of weeks isn’t the worst thing, but it did have some challenges. With knee surgery, you don’t have to worry about it.
Talk to your doctors. Your endocrinologist and your orthopedist. Go over your concerns and see what the plan is. They’ll have glucagon available, and they’ll be able to give you IV nutrition if needed. If you have a CGM, see if you can set things up so they can see the readings and alarms. They do surgery on diabetics all the time. If you have a plan, you’ll be okay.
I have had a few surgeries. I would say just make sure that your PCP and Endo communicate with the surgeon and anesthesiologist that you are diabetic. Frequently they put glucose in the drip that keeps you hydrated and it can take 24 hrs for your glucose to return to normal with all the pure sugar. You will need to do it if you meet up with the surgeon, which usually happpens. You can’t say it enough. No glucose in the drip.
@HopeFloats2020, I had a knee replacement in 2013. There was no infection, and recovery was not so bad after physical therapy (PT). Several weeks of PT helped a lot!
The doctor gave me permission to use my pump during the surgery. Everything worked out very well.
My wife has had her knees replaced in 2009 and 2017. She had very good luck with her recovery.
My wife is not a diabetic, but I am type 1 for 77 years.
Kathy,
I would reach out to your Endo and see what they recommend. My experience is that they do not check your BG during these events and this is usually a patient responsibility, as long as the surgery is short. The Endo usually suggests lowering your basial insulin for the day of the surgery. Regarding infection, you should keep a sharp eye on your BG and try to prevent high BG as best as possible. Ask the Dr/Surgeon what they suggest for post-surgery. Keeping the dressings and wound site clean is a high priority.
I had open heart surgery to replace a mitral valve and do one bypass. The hospital would not let me bring my pump in to surgery and would not let me use it for about 4 days after surgery, because they thought that they could monitor my blood sugar better than I could. They were right. The painkillers left me somewhat groggy for at least a couple of days after my surgery.
Talk to your endocinologist and your surgeon before the surgery to see how they want to handle the insulin needs. Enough people have diabetes that they have almost certainly had others with diabetes undergo surgery.
If the surgeon won’t let you use your pump during surgery, make sure whoever will be looking in on you (spouse, friend, relative) has a stocked diabetes kit (insulin, pump, cartridge/reservoir, infusion set) to bring when you are allowed to start using your pump. Also be sure to have the phone number of Tandem/Medtronic/Omni helpline in the kit in case you need help getting the pump restarted after shutting it down before surgery. (i ran into that problem. Fortunately, I had my laptop with me which had the Medtronic phone number on it.)
Every surgery and every doctor is different. The important thing is to work things out with your doctor in advance, especially since the surgeon probably won’t be around much while you are recovering and the nurses won’t do anything without instructions from the surgeon.
Thank you for sharing!
Thanks so much for sharing!
Thank you for sharing!!
Thanks, John, for the story!
Any surgeon who thinks they can monitor glucose better than a continuous glucose monitor is a loon!! PERIOD. Every time I have had surgery, I have just told the nurses to press the button on the pump to see what my glucose is. My pump automatically adjusts based on the CGM so it is 10 times better than a surgeon, anesthesiologist, or nurse who does not know me.