How is diabetes managed in hospital while having surgery?

[Peanut234]

Hi everyone

I've got surgery coming up and I'm newlyish diagnosed and on insulin. I was wondering how they normally manage insulin while you are admitted/fasting pre surgery/in surgery/out of surgery but not eating normally?

And also when you are home but not eating normally?
I get pretty out of it for a few days after the anesthetic and my family are not up to doing my insulin for me. Though husband is onto it if the libre alarms to his phone.

Goodness knows what the nursing staff will think of me in hospital. Since my last surgery i've developed an allergy to some waterproof dressings, this insulin dependence, the propensity to get pancreatitis just because, another food allergy, and also will have the surgery hip plus the other dodgy hip. Amusingly the specialist sees a lot of very fit athletes, and I feel like I am asking too many questions, but I suspect its because most other patients don't have the additional 'variables' that I do.

I'm feeling a bit of a mess, and the more I can understand about whats going to happen, and plan options for, the better.

Also- do they let you leave on your CGM during surgery? or is it deemed a contamination/infection risk?

Any tips greatly appreciated!

 

[Rachox]

I’m sorry I can’t answer your questions regarding insulin, but I have had two operations in the last year and have been allowed to keep my Libre on for both. They just bandaged over it so it was less likely to get knocked off. It was interesting to see what happened to my blood sugar levels during the op!

 

[In Response]

How insulin is managed in hospital seems to vary.
The "old fashioned" approach which is still used in some areas is known as the "sliding scale" where, I think you have insulin on a drip.
When I have had surgery, I spoke to the surgeon and anaesthetist who agreed for me to remain in control and I was able to keep my insulin.
There is a "middle ground" where we inject but the ward nurse keeps the insulin until meal times.

In other words, I would recommend talking to your consultant about what they plan for your treatment and, if you have a preference be ready to make your point. For example, I would feel very uncomfortable giving my management to someone else but as you are less experienced you may feel happier not to have to worry about it during your surgery.

 

[Squire Fulwood]

I'm a T2 and when I last went into hospital I got the impression that the average nurse didn't know how to manage diabetes. I had a glucose drip in my arm and got high readings which caused concern. I asked if they were sure the drip was helping and was told that it was the only food I was going to get. A nurse confiscated my Glimipiride and locked it in a safe. A diabetes nurse was contacted and she appeared in the middle of the night to give me insulin. I only half woke up and thanked her and told her I was grateful. I survived.

 

[Ushthetaff]

I have to say every time I’ve been in hospital I’ve been in left to my own devices ,when I’ve had an op I’ve had a drip etc , but as soon as I’m out of the operating theatre and conscious the control has come back to myself , which I prefer, I suppose it’s down to your preference , personally I prefer to be in control of my own treatment . From what I can remember they preferred my sugars to be slightly elevated during the op

 

[Jordi77]

While in hospital your diabetes is monitored by the staff by them taking your blood sugars by finger and at the times they are told and that's throughout your surgery and you are also fed and watered and you can do whatever you want to some extent and you will be given a time for when the surgery is to happen and when the porter is coming for you and before you go anywhere that day you will be on a pump with potassium chloride solution and maybe insulin and glucose and then when you go down they take it with you and throughout your surgery you know nothing until you come around and you see what they have done to you and what else they have put in you as a drip and then when you get up on the ward you will have your sugars checked and you will have something to eat and drink and if that stays down you will be able to do something's but you will have to do it with care and that's your surgery done and dusted as I know as I've had plenty of them and know what happens with them

 

[Peanut234]

Thankyou for all your answers.
I think it is going to be a bit of a lucky dip depending on the nurses I get.
Ive been told not to eat or drink from midnight and report at 7.15 am so am hoping I am relatively early on the list.
I think I will have to see how foggy I am after the anesthetic and how much I trust the nurse that is on.
I'm hoping I can keep my CGM on and that should give me some peace of mind. - and I'll be interested to see what the numbers do during surgery!
I'll make sure I find out if I should have my normal basal the night before. I think they are going to have a hard time of it if I don't!

 

[Rachox]

- and I'll be interested to see what the numbers do during surgery!

Guess what time my surgery was!

 

[Peanut234]

Wow! - I hope it went well by the way.

I have recently noticed that my blood sugars go down when I lie down and am in less pain (standing hurts for me at the moment)
I did read somewhere that pain could cause increased blood sugars, but my diabetes nurse said no, thats silly.
I can't think of any other explanation though. - maybe it affects the sensor.
It will be interesting to see what my numbers come back to after surgery too...

 

[In Response]

I did read somewhere that pain could cause increased blood sugars, but my diabetes nurse said no, thats silly.

I am surprised your DSN would say that when I thought it was common knowledge that stress can cause our liver to dump glucose to give use the energy to "fight" whether that is physically fight/flight or whether that is giving the body a chance to heal or whether it is mental stress.
So any pain, illness, difficult situation, etc. can cause BG rise.

Good luck with your surgery.
If you have a preference for your diabetes management, I recommend mentioning it as early as possible rather than having to fight your corner when you are feeling under the weather.

 

[Peanut234]

I had an appointment with a different diabetes nurse yesterday. Thankfully this one will be my usual, the other one was just covering.
She said yes, pain will increase BG, as well as the actual inflammation too which I have (seen on scans) which I had not thought of.

It's just so refreshing to see someone who knows their stuff. Lots of questions and then, 'We're going to adjust this, and tweak that and if that doesn't work we will adjust this... ' A quiet reminder that it actually might take quite a bit of insulin to blood sugar under control and that it it is that the specific circumstances I am in, and don't stress if that happens, its just that we are in a holding pattern until I have the surgery.
I was asking if she had enough time, and she said I made your appointment extra long as I knew we would need extra time, and you are the last one for the day too...
Any questions just get in touch, would you like another appt on this date, no hassle, nothing an inconvenience, no sighing because I am not a simple case.

Knowledgable support, kindness, thoughtfulness. If only all appointments for diabetes, and for all healthcare were like that.

 

[Outlier]

How lovely to have encountered such a switched-on nurse!