Operation - concerns

[BUZZ]

Hi I am due to have an operation on my shoulder and wondered how any of you managed your blood when you're fasting. I'm on a pump but the last time I had an operation I struggled to keep my bg up even having my basal set quite low. Being anxious is not helping and any advice would be appreciated. tia

 

[Deleted Account]

My understanding of basal bolus is that the basal takes care of the liver drip and bolus takes care of the food.
There are things which affect the liver drip such as time of day, stress, exercise, alcohol. But, I thought, if you are fasting, your basal insulin should cover this.
If you find your BG drops when you are fasting, it suggests to me that your basal dose is too high: the way many set their basal is through basal testing which is effectively fasting and measuring out BG over this period.
I assume you are fine over night. The good news is that having a pump you can set a different, lower basal during the day.

When fasting for your operation might be a good idea to avoid the things which lower BG for the 24 hours beforehand: most commonly this is exercise and alcohol.

 

[BUZZ]

My understanding of basal bolus is that the basal takes care of the liver drip and bolus takes care of the food.
There are things which affect the liver drip such as time of day, stress, exercise, alcohol. But, I thought, if you are fasting, your basal insulin should cover this.
If you find your BG drops when you are fasting, it suggests to me that your basal dose is too high: the way many set their basal is through basal testing which is effectively fasting and measuring out BG over this period.
I assume you are fine over night. The good news is that having a pump you can set a different, lower basal during the day.

When fasting for your operation might be a good idea to avoid the things which lower BG for the 24 hours beforehand: most commonly this is exercise and alcohol.

Yep done all of the above but still struggle. Just been given an appointment to see the anaethetist so hopefully I'll get a better idea.

 

[Jenny15]

Yep done all of the above but still struggle. Just been given an appointment to see the anaethetist so hopefully I'll get a better idea.

In my experience the anaesthetist is the best person to help with this.

I learned the hard way that if at all possible, diabetics should have afternoon instead of morning surgery, because the fasting time is shorter. Depending on the type of surgery and other factors, it can be as little as 6 hours. If you can have a light breakfast then enter the fast, it is so much easier.

But if it has to be a morning surgery, that is all manageable too. Another thing the anaesthetist should do is ensure your name is first on the surgical list. This can reduce fasting time a lot.

I'm afraid I can only help with that level of info, since I do not have experience with T1. Remember that the doctors want everything to go smoothly, too, so you will be in good hands. They monitor your BG throughout the surgery and can quickly correct any issue with it.

 

[Ledzeptt]

Hi @BUZZ

I’m a T3c, insulin dependent and largely treated the same as a T1, but I don’t use a pump. I’ve had many surgeries/procedures. It’s good that you’ll have a chance to talk to the anaesthetist about your concerns.

When I’ve been in surgery, I’ve either been given a glucogon injection (I remember one surgeon saying they “loved glucogon”!). On other occasions I was put on the “sliding scale” I.e. glucose drip alternating with fast acting insulin injection to stabilise my BG based on regular finger prick tests.

I don’t have a recommendation for morning or afternoon (mine were often delayed/rescheduled) - please don’t get frustrated/stressed by unexpectedly long waits; emergency surgeries will take priority.

I hope it goes well and you recover quickly.

 

[Wjohn]

Hi I am due to have an operation on my shoulder and wondered how any of you managed your blood when you're fasting. I'm on a pump but the last time I had an operation I struggled to keep my bg up even having my basal set quite low. Being anxious is not helping and any advice would be appreciated. tia

Hi ,
Whilst not on a pump I have been a type 1 injecting for 54+ years ,and did have a shoulder op last year .
I spoke with the surgical team ,they were excellent and we did the following ,
Had one of the very early in the morning operating slots ,
Had a local anaesthetic. Was awake throughout , I would recommend this .
Discuss with team the BG level they would prefer and try to achieve this ,they can arrange their own drip feed to maintain a set level ,
I have ,recently had shoulder ,elbow and hand ops and have had this procedure and would recommend it.
All the best wjo

 

[Ian_P]

Hi Buzz,

Please don't worry at all - I'm an anaesthetist with T1DM myself. We're very used to dealing with diabetes and surgery. Your hospital will have its own protocols for insulin pumps and surgery. We can do a lot of shoulder surgery under a regional local anesthetic block now too, with or without sedation.

Let me know if you have any questions after you've seen your anaesthetist.

Best wishes,

Ian

 

[LittleFeather]

Yep done all of the above but still struggle. Just been given an appointment to see the anaethetist so hopefully I'll get a better idea.

See your Diabetic Educator. I am on a pump and have been through 3 surgeries since I have been on it. I eat dinner, as usual, then set a temporary basal for midnight of 1/2 the usual rate. This causes me to run a little high in the a.m. but that is ok. as long as you are under 200mg/dl. I also request an early morning surgery (if at all possible) so that you can get back in to regular routine as soon as possible. Leave your infusion set in, suspend your pump and disconnect from it. Re-connect as soon as you can after surgery and do a finger stick. Make any correction for high or low glucose and you should be set to go from there.
Hope all goes well for you.