Use of pump temporarily whilst in hospital

[Trulee]

Hi All
Am after some thoughts and a bit of advice.

I am due gallstone surgery next Wednesday. At my pre-op assessment this morning the nurse, very matter of factly, told me that they would 'more than likely' put me on an insulin pump for the duration of my stay, even though my sugars are pretty well controlled and I am quite able to manage my levels myself. The surgery is not long (1-2 hours), and the fasting element, due to the time of surgery is quite manageable.

Knowing very little about pumps this has alarmed me more than a little - would I be within my rights to say no I don't want a pump in this situation?

I am worried that if I go down this route in hospital, I will suddenly end up with a pump for the rest of my life, which I don;t think I can cope with, either physically or mentally at the moment.

Many years ago I was given the same scenario with insulin after a heart attack, and guess what, never managed to get back off the insulin afterwards either :-( , so you can see why I am in this state.

Has anyone any experience of using a pump temporarily whilst an in-patient, and what was your experience? Would you recommend it, or have you gone the other way and continued to monitor your blood sugars yourself and administer your normal shots as needed? I am happy with the way I manage my diabetes, and have always had good support from my Diabetic Nurses.

thanks for taking the time to read, any feedback would be good.
Trulee

 

[noblehead]

I can't say I've heard of anyone using a pump temporarily whilst in hospital (that's not to say it doesn't happen), usually the options are to manage your insulin yourself or they put you on a sliding scale.

 

[satindoll]

You have the right to refuse the pump if you don't want it, as long as you can show you are capable of managing your jabs yourself and have steady levels, which is where your Monitoring Diary comes into play, they should let you continue doing your own thing........Last September I was an in patient for a broken hip for which surgery was required and they were happy to let me do my own jabs and tests as it didn't put extra work on the nurses shoulders, though they did come round and test me at times just for their records.
Good luck with the op.......been there done that.......lovely to be rid of the pain.....

 

[Trulee]

thanks Noblehead - those were the options I have been offered in the past. Was just a bit shocked that the use of a pump seemed to be so commonplace to her

 

[Trulee]

thanks Satin Doll, unfortunately don't keep a written record, but guess they could tell from my meter what I get up to. I think I would rather go without it if at all possible, I am a perfectly sensible 50'something woman who has managed this disease quite happily for the last 20 years or so.

 

[noblehead]

thanks Noblehead - those were the options I have been offered in the past. Was just a bit shocked that the use of a pump seemed to be so commonplace to her

Me too, but perhaps things have changed?

Here's an old thread, you will see the very knowledgeable member @phoenix (who lives in France) was temporarily given a insulin pump when she was admitted to hospital:

http://www.diabetes.co.uk/forum/threads/what-is-a-sliding-scale.40394/

Good luck with the operation and hope your recovery is swift.

 

[satindoll]

I don't think you will get away with not taking your insulin with you and not something I would recommend, mind if its on a Day Surgery basis you might just wing it.

 

[Trulee]

Me too, but perhaps things have changed?

Here's an old thread, you will see the very knowledgeable member @phoenix (who lives in France) was temporarily given a insulin pump when she was admitted to hospital:

http://www.diabetes.co.uk/forum/threads/what-is-a-sliding-scale.40394/

Good luck with the operation and hope your recovery is swift.

thanks Noblehead - good link - will give it a proper read at home later

 

[Trulee]

I don't think you will get away with not taking your insulin with you and not something I would recommend, mind if its on a Day Surgery basis you might just wing it.

would normally be day surgery, but with the heart condition he wants to keep me in overnight and out the following morning.

think I am going to take all my own meds with me and try to insist that I will manage whatever is needed

 

[Trulee]

would normally be day surgery, but with the heart condition he wants to keep me in overnight and out the following morning.

think I am going to take all my own meds with me and try to insist that I will manage whatever is needed

sorry - just read my original response, meant without the pump, not the insulin - sorry!!!!!

 

[satindoll]

would normally be day surgery, but with the heart condition he wants to keep me in overnight and out the following morning.

think I am going to take all my own meds with me and try to insist that I will manage whatever is needed

Go Girl........definitely take all your meds and be sure NOT to let them whip them away, keep them in your locker, and tell them you WILL manage your diabetes yourself........after all your not a kid.

 

[Deleted Account]

Very interesting.
I am a pumper and have recently undergone surgery. The nurses and surgeon were keen to take my pump away from me and give me something they were familiar with: a drip that they could control.
However, the guy* responsible for keeping us alive during surgery is the anaesthetist. He was brilliant. We talked through how my pump worked and how I control it. Then he was happy for me to continue with my usual diabetes management.
During the operation, my BG was taken every hour and based on this, they were able to adjust my Bg (if necessary) through the drip with either additional insulin or sugar solution. Thankfully this was not needed.
As soon as I came round, I was back in control under observation: they took a finger prick every hour and I decided what to do about the results.

Although our positions appear reversed, I think the lessons I would take are
1. The anaesthetist is the guy you need to convince
2. Practice calmly explaining how you manage your diabetes and why you do it this way
3. Be firm with nurses, etc but try not to get upset when they disagree with your plans. Remember they are not the ones responsible for keeping you alive during the surgery
4. Be confident that, during the surgery, they can temporarily manage your BG but this is only whilst you are unable to do so
5. Take back control as soon as you can
6. Prove you are in control
7. If your op is in the same hospital as your Diabetes Nurse, ask them to speak to the operating staff (my surgery was in a different hospital so this was not possible but the Diabetes Nurse made the offer)

Good luck and I hope the surgery goes well

(* I use the term "guy" in a gender non-specific sense)

 

[Trulee]

Thanks for that very sensible advice- you are right abaesthetist is the person I need to convince - sure it will be ok in the end just threw me a bit this morning

 

[donnellysdogs]

I think they are talking about putting you on a sliding scale possibly?? Not a pump....

Personally, I've had two admittances for 2 hour ops and both times I warned them that I was going hypo.. the ward nurses were awful. Thankfully the second time my diabetes educator had come up to see me (absolutely lively lady) and she saw exactly what happened. They didnt even have the right percentage glucose drip attached. The ward nurse also decided to treat a lady with a raised temperature before me. I was due to go for surgery on 2nd one within 30 minutes!!
I sucked 2 sugar cubes and the ward nurse came back and shouted at me that the op would be cancelled, and she would have to tell the anaethetist...she never apologised that she was wrong. I had sucked the 2sugar cubes as I knew they would be absorbed through my mouth..... I had my op.
This was despite the 2nd op consultants and specialists all knowing what went wrong at a different hospital and my fears and concern. They had adjusted the rates to what tgey thought would be okay...

I am due a 3rd op before the end of the year. Hoping this time it will be 3rd time lucky!!

Thats my experience. I havent known any hospital to put anybody from mdi to a pump.. to sliding scale yes...

They could not put you on a pump because of the risk of a cannula blockage. They will have to put a drip (sluding scale) in your arm.

I also had a cgm at the time and had to remove it before the op. Incase they need to use an electric saw gadget on me. It could have arced to my sensor apparently..

Also my sensor in hospital was not accurate at all. My electrical senses in my body must have been all over the place and no where near my actual blood readings.. the pump educator had been looking at my sensor readings that mirning and came to see me thinking they had got me to my op without hypo!! I laugh now, she admitted she was mortified when she realised what was happening!!

Thats my experience. I am unusual though.. I dont think many people have the same regimes as me with insulin daily let alone hospital incidents as well..

 

[Struma]

Hi All
Am after some thoughts and a bit of advice.

I am due gallstone surgery next Wednesday. At my pre-op assessment this morning the nurse, very matter of factly, told me that they would 'more than likely' put me on an insulin pump for the duration of my stay, even though my sugars are pretty well controlled and I am quite able to manage my levels myself. The surgery is not long (1-2 hours), and the fasting element, due to the time of surgery is quite manageable.

Knowing very little about pumps this has alarmed me more than a little - would I be within my rights to say no I don't want a pump in this situation?

I am worried that if I go down this route in hospital, I will suddenly end up with a pump for the rest of my life, which I don;t think I can cope with, either physically or mentally at the moment.

Many years ago I was given the same scenario with insulin after a heart attack, and guess what, never managed to get back off the insulin afterwards either :-( , so you can see why I am in this state.

Has anyone any experience of using a pump temporarily whilst an in-patient, and what was your experience? Would you recommend it, or have you gone the other way and continued to monitor your blood sugars yourself and administer your normal shots as needed? I am happy with the way I manage my diabetes, and have always had good support from my Diabetic Nurses.

thanks for taking the time to read, any feedback would be good.
Trulee

I think you and the nurse are taking about different pumps.
It is quite the norm now to have a 'pump' to cover surgery. They have been used in my experience since 1986.
In actual fact, for a really major operation the IV insulin is commenced at 06:00hrs on the day of surgery. Remember stress = raised BG?
In hospital various names abound- syringe pump, pump, VRII (Variable Rate Insulin Infusion), sliding scale insulin. They're all the same thing, continuous intravenous insulin. It is adjusted in rate according to your BG.
Tight control of BG, during surgery, in a short time frame, has shown very effective both in healing and also in homeostasis.
Like surgery, having a heart attack is a major disruption to the body, and is treated the same with IV insulin.
On this forum, the pumps are for long term administration of subcutaneous insulin, it's a different ball game.
I think you're quite right to question the protocol, and ask the anaesthetist's opinion, but let someone know in good time so things aren't left too long.
Wishing you good luck with your operation.

 

[catapillar]

I would agree that you and the nurse are probably talking about different things. When you say insulin pump you mean continuous subcutaneous insulin infusion and wearing a little device that delivers insulin. These aren't recommended for type 2 diabetics and aren't prescribed to or funded for type 2 diabetics via the NHS. When the nurse, assuming she's a general surgery nurse and not a diabetic nurse, talks about an insulin pump she means receiving insulin via a drip. That is common for those on insulin during surgery. That is temporary.

If you are dead set on retaining control of your diabetic management while in hospital of course you can refuse. But bear in mind there may be time when you are incapacitated by the op, pain or anaesthetic, and unable to competently make or administer dosing decisions. And there may be times (pre and intra operatively) when the clinicians might have different and specific blood sugar target than you might usually apply.

 

[donnellysdogs]

Some hospitals do not take you in until a couple hours before surgery! I was due to go for op at 2.30 but admittance not till 12.00. It was changed to 9am.

They want to cover all angles of safety during an op. Although the likelihood is minimal... things can go wrong... ie for me they may have needed this electrical saw thing... so I had to remove sensor and they cannot guarantee everybodies ops 100% so just in case the anaethetists generally prefer sliding scale. (What you are calling a pump).
They wouldnt want to be fafging around in theatre trying to get glucose/insulin in your vein when the drip could already be in place.

They have basic guidelines to follow for when the drips are actually in use/not in use... they do not regularly test as I wanted to.. so I was doing my own tests when I wanted.

In view of my two mess ups as described above... would I want a 3rd sliding scale at my next operation?? Yes...

Yes, because I know that things can go wrong. Bleeds can occur, all sorts of things.. I want to know that if anything chronic happened in surgery that they would have control of my diabetes.. at least! My levels when I got to surgery were 4.4 and 7.0 after.. they did look after me in surgery and recovery..

My incidents are not the norm...

You will be advised what insulin to take on the morning of admittance and they normally hand control back to you as soon as you are back in the ward.

 

[mariposa84]

I've had a sliding scale during my ops with general anaesthetic and I feel more comfortable that way..only because they are very used to testing and adjusting insulin/glucose in surgery. After surgery they got me back on my insulin pens ASAP so that they could see I was capable of looking after myself before discharging me.

It seems to me there's been a general shift recently in Dr's and nurses attitudes towards giving you your control back ASAP. I've had them say to me you live with the condition everyday and you know more about it and how your body responds than we do.

Some years back I had a horrible nurse who flipped out totally when she realised I had my pens on me...confiscated them from me and stored them in a fridge. She made me tell her how many units I'd taken with my breakfast and when I told her my overnight blood sugars and how much insulin I'd had the night before she retorted "I couldn't care less about that, I wasn't on duty then".

Hope your op goes well

 

[gavin86]

I'm guessing it varies a lot.
You always have the option to refuse a treatment. That said, a surgeon have the option to say they won't do it.

When I was in hospital I administered my own, but they hung onto the pens, tested me, and knew what doses I was on. I was newly diagnosed while in hospital for other critical conditions though, so think they were more cautious. ( I started off on IV insulin, then moved to sliding scale for the first few days, then took over)

 

[donnellysdogs]

I was given pens back as soon as in ward.

All points needing considering and asking to make. Sure you are happy xx