insulin adjustment for surgery

[amrita86]

Hello, I am looking for some additional advice... I am due to go in for a surgery this Thursday and being type 1 diabetic I will be first on the list. I have been advsed by the surgeon and nurse to have my dinner the night before and take insulin as normal but avoid any morning doses and food after midnight.
I follow a low carb regime and intermittent fast which I have been doing for the last 2 months.
i begin my day taking 10units of levemir at 7am and then 10units levemir again in the evening at 6-7pm.
my normal routine is to miss breakfast, have a black coffee with coconut oil in the morning and then a sugarfree redbull at 1pm with maybe a tablespoon of double cream to keep me going. at 6-7pm I have two scrambled eggs with butter and some cheese. at 9pm I have a small packet (50g) of saltpeanuts (my desert as I love them) . I avoid eating after this and repeat the same thing the next day.
my blood glucose is controlled but occasionally if I overdo it with the peanuts I have a rise in glucose at 2-3am and sometimes I can wake up with a blood glucose of 7.8mmol which I have to give a correction dose for. I take 1unit of novorapid for my eggs and peanuts split into 0.5units first for the eggs and then 0.5units for the peanuts later on.
I am thinking of continuing to eat the same prior to my surgery to avoid any alterations in my blood glucose.
my concern is not to take my morning levemir which is what they have advised. Do I increase my evening dose as I am afraid I will hypo if I do this. please advice on how I can alter my basal insulin to once a day and avoid a hypo on the day of the surgery.
I look forward to your responses, many thanks x

 

[1abRat]

They are giving you terrible advice to skip your Levemir UNLESS they're planning to put you on an insulin drip.

You definitely need to get this clarified with them. If they aren't putting you an an insulin drip (sliding scale) your blood sugars will end up very high, probably too high for surgery.

When I had surgery a couple of years back I simply reduced my basal insulin (Lantus at the time but the same principle applies) by 10% before the surgery and used my fast acting insulin to make small corrections during the day.

It might be a good idea to get someone from your diabetes care team like a DSN to call the anaesthetist and sort out a proper plan for you.

 

[Engineer88]

Pre sergery advice is terrible for diabetics. I went private in march and they wanted me to half my insulin from 7am when i was haviung surgary at 1pm. ummmm NO!! I tested regularly (every hour) and was on CGM. you still need your background, I would suggest speak to DSN who hopefully will help!

 

[amrita86]

thank you for your advice... i will call them now and confirm.
stranglely though today i didnt take my morning levemir and my blood glucose has been at a constant 6mmol. whereas in the past i noticed it droping abit quite quickly and i would have to chew sugarfree gum throughout the day to keep it from dropping (for some reason it worked). what i w as planning to do today was miss my levemir this morning (which i have) assess my blood glucose throughout the day (i also have a libre) and then at 8pm take my levemir dose 10units and see how it goes? i think i am quite insulin sensitive and i normally have to snack on nuts to prevent my blood glucose going low. maybe i am on too much levemir. i also noticed since i have stopped exercising my insulin requirements for levemir are dropping.
i havent yet done the basal test and i need to do it but prob now afetr my surgery as i dont want to change alot to my current routine to go off the scale x

 

[slip]

I suspect they were thinking you are a 'normal' T1 who takes basal once a day in the evening and 3 bolus for 3 meals - best you clarify exactly what they and you want.