surgery and diabetes

[scoots]

Hi All,

I'm due to have a major op to remove large fibroid and uterus. I am fully aware of the complications associated with raised bs post-op in terms of healing, infection etc, and am keen to get my bs on track, however it is sooo difficult as inflammation in itself increases bs/insulin resistance. One of the first symptoms I had, in May this year before any gynae symptoms, was that my insulin ratios changed so that I needed more insulin to being bs into normal range; this has been a continuing feature, and I now need to correct to bring bs down rather than just 'know' it will be the correct ratio. And then at times it will go back to normal and I'm in a run of continuing hypos!

Obviously I want to give myself the best possible chance, and am planning a military fitness kick to get it sorted for my op on 16th March...!

I know of people who have had their ops postponed due to raised HbA1c, however my HbA1C has been raised for a while due to this issue with the ratios (it was 9 last time, usually 7 and below). I really don't want the surgery to be postponed, however my pre-op assessment is only a week before the op, and it looks as though I will be admitted on the same day as the op. I also have an appointment on 21st Feb to start using an insulin pump, so should be able to get better control with the pump, however I'm not sure whather it will be too late to have that much effect on bs, certainly not HbA1C.

Has anyone else had any experience of bs control affecting surgery? If so, how did you manage it?

Jen x

 

[noblehead]

Jen,

I would discuss this matter with your diabetes consultant, switching to the pump on the 21st February is pretty close to your operation date on the 16th March and you may find that your control maybe more erratic for the first few weeks (although some pumpers may be able to advise here). I don't want to sound negative but I would definitely seek professional advice but do hope you have a successful outcome with your operation and insulin pump switch.

Nigel

 

[iHs]

I've sent you a PM Scoots

 

[scoots]

Thanks to Nigel and iHs for your good advice.

I had thought to call my DSN to ask if there is any possibility the pump appointment could be brought forward, I'll call them on Monday to discuss. My main concern really is that the op is not put off, so if that means I go on the pump a bit later then so be it.

Ho hum, the joys of balancing life with diabetes...!

Jen

 

[noblehead]

Ho hum, the joys of balancing life with diabetes...!

It certainly does complicate things diabetes, but hopefully your surgery will go ahead without any problems. I had surgery last year and on the morning of my op my fasting bg was 5-6mmol, one hour before the op it shot up to 12 (stress I would imagine) but they said it wasn't a problem and the surgery went ahead without any issues, so good luck yours!

Nigel

 

[sugar2]

I have only had a c section in recent yeras...and this is not teh kind of surgery that can be postponde! If they make noises about postponing your surgery..I would pint out that the reason you are having teh surgery, is teh reason for your higher than normal HBA1c...so delaying it would not achieve very much!

I, personally found that my control, on going on the pump improved fairly immediately...it wasn't perfect, but then it wasn't prefect before either...sounds like you are a testing expert already...so I would go for it as far as teh pump goes...but if they can move it forward, even better.

 

[cugila]

Just a bit of information here from The Association of Anaesthetists of Great Britain and Ireland guidelines for Anaesthetists.

It isn't so much the HbA1c they will be looking at but your Bg levels as well as ALL other tests on the actual day.

So if you have no other problems AND your Bg level is not 'out of this World' there shouldn't be a problem on the day.

See below.........

Pre-operative primary care

Primary care can help optimise patients’ fitness before surgery by offering advice on smoking cessation, exercise and weight reduction, and by optimising treatment of chronic conditions
such as diabetes and anaemia. This may help increase survival, decrease peri-operative morbidity and shorten the duration of hospital admission.

General practitioners (GPs) can help advise patients on which drugs to continue or discontinue peri-operatively in liaison with the pre-operative anaesthetic clinic.

 

[scoots]

I have spoken with both my GP and my DSN today, and the advice given was exactly that given above - how good is that?! So, I'm getting an MOT blood-wise to address any anaemia etc., going ahead with the pump fitting in Feb leaving enough time to get some better control for the op in March.

My DSN did say that they would be looking at the blood glucose levels on the day rather than HbA1C, which makes much more sense. As you say, it would seem ludicrous to postpone the op due to a symptom which is as a result of the underlying condition, and which hopefully should be resolved with the op. She also advised to aim for a slightly higher level of 8-11, as I would be more likely to achieve this without lurching from hypo to hyper (which has been happening recently, nightmare). She also said that as soon as I am eating and able to do things for myself I should be able to resume the pump even in hospital, which is great news as I want to avoid the dreaded sliding scale insulin as much as possible!

I don't know about being a testing expert, I do my best but am far from perfect! :wink:

Thanks again,

Jen

 

[))Denise((]

Hi Jen

I'm a Type 2 but had the same operation (for the same reason) in Feb 2008, three months after I was diagnosed. I didn't have a bg meter at the time but the anaesthetist said that they would keep my levels slightly higher than usual. I would be more concerned about being anaemic and to make sure that you get this treated properly. I recovered more slowly than non-diabetic people.

If you want support about the operation there is a good forum on the Hysterectomy Association website.

 

[huckboo]

Hi,

I too am having surgery on my uterus at March end and am trying to get my BG under control so I was very glad to see this thread. My surgery is to remove a polyp discovered through ultrasound. I have no particular symptoms but my GYN has recommended it be removed as she thinks I am estrogen dominant. I am menopausal since July 2009. I self test and see readings between 6-8 mmol randomly throughout the day. This is since I have been on South Beach Diet, which I started last week. Under this diet, I eat every few hours. I take 3x500 Metformin (2 at night.) I have not been under good control since November, with highest BG I've seen prior to starting my diet up to 12mmol. My last HbA1C was 6 but that was in March 2010. I am scheduled to give blood for another HBA1C on Feb 23 and meet with my GP March 2. Pre-op is March 21 and surgery is March 29. I am 6.5 stone overweight and very nervous. I hope to lose 1.5 stone by the surgery date.

My problem is that my BG is always high in the morning. It seems to go up 1-2 mmol every night. This morning it was 8.5 mmol. It is strange but usually my BG will go down after I eat. My surgery is scheduled for 11:45AM. Today I experimented and didn't eat until 10:30AM and my BG dropped from 8.5 mmol when I woke up at 9AM to 8 mmol after drinking black coffee. I know I will not be able to eat that morning due to having to undergo anesthesia. I am wondering if maybe I should try and fast for a full day before the surgery. Has anyone got any thoughts about this strategy?

I am hoping to hear more from members who have undergone surgery, especially obese ones. I wonder if I have enough time to make a difference if I am very strict with my diet. Under good control prior, I would wake up with 6-8 mmol in the morning, instead of just randomly throughout the day.

Thanks to everyone on this very interesting and informative forum. This is my first post. Please forgive me if I have inadvertently broken any protocol. I do not mean to hijack this thread but didn't feel I should start a new one as my situation and Jan's seemed so similar.

Lisa x

 

[cugila]

Hi Lisa.
Welcome to the Forum.

Surgery.......I have been a Diabetic for close to 14 yrs, Type 2. In 2004 when my Diabetes was out of control I had a Triple By-Pass Heart Surgery. I had to fast from 10pm the night before and the Op was started at around 9am.........finished many hours later.

Bg levels were high, over 10 prior to the Op but as I was otherwise in reasonable health the Op went ahead. No problems. As I have posted in this thread previously,

It isn't so much the HbA1c they will be looking at but your Bg levels as well as ALL other tests on the actual day.

So if you have no other problems AND your Bg level is not 'out of this World' there shouldn't be a problem on the day.

If the levels are high they will control them before, during and after the OP. If still concerned this is something you should discuss prior to the Op with the relevant Dept or your GP.

 

[huckboo]

Hi cugila,

Thank you for the welcome and quick response. It is great to hear your story of successful surgery. Were you obese then? I am very overweight. My GYN said she operates on many obese women with no problem, but I am still worried. I am anxious about my upcoming blood work. I have only been eating decently for the last five days. I have less than four weeks till I give my blood for labs with my GP, and less than nine weeks until surgery. I wonder how much I can improve things with a strict diet in the time frame I have.

In March 2010, My Total cholesterol was 4.4 mmol but I do not think it will be that good this time. My triglycerides were 1.5 times the high end of the normal range. My HDL was low as it always is. I also had high ALT due to fatty liver. I don't know how long it takes to turn around my BG and other bad blood work. I have also had abnormal EKGs for years. I was given a nuclear stress test in Feb 2009 which returned normal results. I am on Benicar HCT which keeps my blood pressure controlled. I do not know how unhealthy I am considered. What would you call "reasonably healthy"? And what BG would you consider "out of this World"?

I will definitely talk to my GP March 2nd but, like Jen, want to put myself through a strict bootcamp of sorts. I think most of my issues are weight-related. I don't really feel bad other than I get this buzzing feeling throughout my legs/groin/chest on occasion (at least a day a week.) But the feeling is so random, I have about convinced myself it is related to menopause. I thought it might be the Metformin causing B12 deficiency but I have been getting shots which have made no difference. Neither my GP not GYN had ideas. My GP felt the pulse in my ankle and said circulation was fine.

I have been on Metformin and Benicar HCT since I got the nuclear stress test (almost 2 yrs.)

Lisa x

 

[cugila]

Lisa.

Yep I was over 19 stone at the Op time. Not any more though Lost over 5 1/2 stone since 2009.

I know it's worrying but you need to trust the staff .....they will look after you. Don't go too mad with exercise and stuff and 'do yourself an injury ' ........then you definitely won't get the Op.

You will be fine....... :wink:

 

[huckboo]

Thanks cugila. I am over 18 stone. How wonderful it must be to lose so much weight! I see your diet is low GI/low carb so I feel quite heartened by your example.

Thank you for your encouraging words. I have been putting this surgery off for a long time (years since the polyp was first noticed.) We have been "watchful waiting" but my GYN says it is time to do it as my uterine lining is getting "fluffy" so I feel I cannot postpone till I can lose what I need to. I trust her completely but I know nothing about who will perform the anesthesia as it is just done by whoever is on duty that day. That makes me uncomfortable. I am also afraid of recovery as I have some astrological aspects that are not great for the days following the surgery. I know that seems like a silly and unscientific concern, but I still think about it.

How was your recovery process?

Thanks again,
Lisa x

 

[huckboo]

Hmm cugila. I see you are male so I think you must have carried your 19 stone over much more height than me. Even though you weighed more, I am probably bigger than you proportionately.

 

[cugila]

Lisa.
Yes, losing weight has turned my life around......not to put too fine a point on it if I hadn't I probably wouldn't be around any more...... A brilliant incentive.

The recovery process after such a major Op went brilliantly, out of hospital on Xmas Eve after 4 days and from then on just did everything the Dr's told me. Within a week or so I was walking at least a mile or two each day and gradually over many months built up my fitness levels and stamina to levels I thought were long gone. The best thing that ever happened to me in a way....apart from discovering this Forum......

Put your trust in the people who WILL be looking after you. They are ALL highly trained and you can have confidence in them. I went into the Op saying a prayer or two.......I am still here, so something must have worked. As for Astrology I'm afraid that is not something that bothers me but I can understand your fears. There is little I can do to address that other than to say, trust everybody. Try not to worry........easier said than done I know.

Just seen your latest post.......yes, just short of 6 ft but was Obese. I also had high BP and Lipids were all over the place as well. Swings and roundabouts maybe.......

TRUST........

 

[scoots]

I agree, you need to trust that things will go as they should - stress releases cortisol, which increases BG and BP, neither of which are good pre-op.

Not knowing what had caused my symptoms, I had myself dead and buried over Christmas. I see this as a second chance to get fit not just for the op but for life, taking control of my diabetes (also looking forward to going on an insulin pump 21st Feb) is and my general health and fitness.

I have been making a point of walking an hour a day, which I think has really helped to stabalise my BG and will hopefully get me to the target of losing a stone pre-op (over 8 weeks, whould be realistic).

It's good to see you are looking to get fit in the same way, I wish you all the best for this and the op. Let us know how it goes!

Jen