Type 1 URGENT help/advise needed

[Ewan1]

I am due to go in to hospital, for major op. Told not to eat or drink from 5.00am, no idea when i will be going to have op

what should i do with my long acting levimir insulin

many many thanks

 

[azure]

@Ewan1 Tagging @donnellysdogs as she might know.

when is your op and when do you normally have your Levemir? Can you phone the ward for instructions?

 

[catapillar]

Wasn't this covered in your pre op assessment? The point of basal insulin is to keep you flat when not eating or bolusing so, provided your basal dosage is actually correct for you, it should be fine to take levemir as normal prior to a fasting period. It's worth checking with the ward if you are unsure and if discussion of your insulin wasn't covered in pre op assessment you should make sure they know you are diabetic - might get you bumped up the list.

 

[Ewan1]

thanks for the answers, all is a bit sudden, i'm having my pre op the day before and i know how these departments communicate so am concerned, i know my levermir seems to spikes ? I'm thinking of lowering it, but by how much? I know at pre op, they will say contact a specialist, currently not in contact and no time.

many thanks

 

[donnellysdogs]

I am due to go in to hospital, for major op. Told not to eat or drink from 5.00am, no idea when i will be going to have op

what should i do with my long acting levimir insulin

many many thanks

You should go through this with your pre op assessor.

I suspect you will be allowed your basal but they may want to adjust how much.

Some hospitals for a 2.30 afternoon op will take you in at 7.30, some 9.30 and some at lunchtime. These times varying can alter basal injections. Only you know your body and know uf suggestions from pre op assessor will affect your bloods.

It also depends whether you are going to be put on a sliding scale. Most people are. My 1st major op the sliding scale was wrong for me, second time op and they adjusted but it was still wrong.

Whatever they decide you must take in your blood meter and check yourself if you think your levels are going array. I had one nurse looking after a ward of 6 ladies and didnt take my warnings to her of hypo looming quick enough. I took in sugar cubes after the first mess up. As this nurse took so long and they had the wrong glucose drip up I sucked two sugar cubes. She then let rip at me in the ward.. shouting that op would be cancelled, she'd have to contact anaethetist etc.. my op still went ahead but no apology for shouting or delays.

So also find out if the nurse is busy and you go low, can you suck a sugar cube?
This will depend upon the op tgat you are having though..

I have had extreme unlucky incidents. Very, very rare ones and this is why I recommend that you basal test if you can before hand. Ie if its a stomach emptying op this will be very limited eating before hand and that definitely lowers the basal insulin required. I practised the week before as I knew when they give the bowel cleaning drink that should clear stomach out in 2 days, mine takes 5 so I had to limit food for 5 days not two.

Talk to your pre op assessor. If not happy ask for happy ask to have your consultant included with basal pre op etc.

I have a cgm and I was not allowed to wear it for op so took it off just before going down. It was not at all accurate that day as my electrical signals in body must have been in overdrive. I wasnt allowed to wear it in op incase tgey needed to use an electrical saw that could arc against the cgm.

Hope op goes well...

 

[Ewan1]

thanks for the above, nil by mouth from midnight, i will have a small strong coffee before i leave home, think will lower lev, and take glucose jell.

i will discuss in pre op, not sure if i will see my consultant until after op.

thanks for help.

just thought, might drive to diabetic clinic and see if I can see someone

 

[donnellysdogs]

Pre assessor normal before.. then anaethetist in day. Sometimes consultant.

My team this tome round were very, very exceptionslly good.. despite still not getting sliding scale right for me.

 

[donnellysdogs]

Normally the pre op assessors are good.. and they specialise pre ops.. diabetes nurses have lesser clue than the pre ops but generally know the patients.. so can advise but they dont deal with diabetic ops day in day out...

 

[Daibell]

Hi. Yes, do discuss at the pre-op. Hospitals usually try to do diabetic patients earlier in the day. In general do the Basal as usual but perhaps reduce it just a little to avoid the possibility of a hypo. My advice is to keep hold of your insulin and don't let the nurses take it away and take control. They can do meter checks but not manage the insulin itself. Also be wary of any hint at them using the so-called 'sliding-scale' management of insulin by drips; it can be a disaster waiting to happen and isn't needed. I've had a few ops and the staff have listened and together with me have done a good job with blood sugar control.

 

[Ewan1]

many thanks

 

[donnellysdogs]

Some hospitals though for major ops are insistent with sliding scale. Both mastectomies and despite bug problem on 1st op at 1st hosp I still had to have it at next hosp and next op and a further mess up. Having 3rd op end of this year and At my 2nd hosp but dont know their plans yet for diabetes side of things.

Some hosps take you in at standard morning time and tell you that you will be first down... but dont tell you that the surgeons dont operate till afternoon. So do check what the actual time planned for op is...

I knew times of my ops but know of someone else thinking they would be furst down and a morning op... but was an afternoon one.

 

[Ewan1]

thanks very much, pre op tomorrow so i will ask, op on friday.

 

[donnellysdogs]

Good luck @Ewan1. Hope you get on ok tomorrow and Friday.

I think it a lot depends on the actual op and what thinking the anaethetists have given to pre op assessors.

If you have doubts or questions etc ask them..

Ie ....

1) what bg level wouldnt they do the op at ie 18....or 14 etc... as going in to have an op done can cause a bit of anxiety etc.

2) if levels go low pre op what can you take and the op still go ahead... (ie glucogel rubbed in gums??).

3) if you normally correct for highs, check if this is allowed still or whether they just want you without correcting...

These are important to ask... as well as finding out about taking basal....

 

[Ewan1]

Well that went well!!!!!!

Pre op nurse just said, don't take your insult, when I questioned this, she said I will email the doc, of course he didn't get back, so none the wiser. So i will perhaps take a very reduced long acting, if i need to.

Thanks for your support and help, will have to wait and see

many thanks

 

[donnellysdogs]

Well that went well!!!!!!

Pre op nurse just said, don't take your insult, when I questioned this, she said I will email the doc, of course he didn't get back, so none the wiser. So i will perhaps take a very reduced long acting, if i need to.

Thanks for your support and help, will have to wait and see

many thanks

Hi!!

Hope your op goes ok.. but that pre op advice??? Since when does any Insulin Diabetic stop taking insulin?

I so hope all goes well, please let us know how you get on.

Thinking of you..

 

[Ewan1]

Well, what a story, arrived, changed into gown, bracelets put on, then anethatist pops along, asks about insult, i advise I haven't had any as per instruction, he tells me to take half my levamir dose ! Anyhow the consultant pops along just as they were putting in the drip, has a chat and states he wants to do further investigations first, so discharged, more MIR's booked

Thank you for all your support

 

[donnellysdogs]

Omg.... lets hope MRI's done quickly and that you know next time to take 1/2 dose.
Did your levels go high with none?

 

[donnellysdogs]

Would they have put you on sliding scale?

 

[Ewan1]

In the morning my bloods were 10, unusual for me, so I took 2 units of actrapid, 5.00am. so when he told me to take have my levamir my bloods were still 10, at 09.30, then about 10.00 when they postponed/cancelled op i took more actrapid.

when early on i voiced my anxiety, no one was in a hurry they just said 'we'l take care of it' only the anethasist who advised to take the levamir, no one said anything else, so don't know what they would of done.

thanks donnellysdogs

 

[donnellysdogs]

Concerns me, as an insulin dependent diabetic should never be told to take no insulin.....

I think our bodies can just up our
Bgs' unconsciously the night before ops.