Questions? Operation,insulin dose, long day

[Robinredbreast]

Hello :wave:

On Wednesday I am having an operation. I have to arrive at 12.30pm and the Op will be sometime in the afternoon. I can eat my breakfast and have a drink before 7.30am, and then if needed some water or very diluted juice before 11.30am, but then nothing at all. The doctor at the pre op assessment said not to take any insulin with my breakfast, but I said my blood sugar would be sky high if I did that, so after a bit of umming and arghing he suggested 3/4's of my normal insulin.

What concerns me is going without food and liquids for possibly a few hours and not going low and trying to keep a reasonable level. Has anyone got any good tips or advice about managing BS before an operation or have you had an afternoon operation. As it's now getting closer, I'm starting to feel a bit anxious and how did other people get through their ominous day ?

Thanks so much in advance

Best wishes RRB x

 

[hanadr]

Some years ago, my husband had a minor operation, which they did under a combination of sedation and local anaesthetic.
It meant he wasn't off his normal routine.
Can they do this for you?
Otherwise, with general anaesthetic, they usually apply a sliding scale drip routine.
I'd suggest, if you are in charge of your own control, you use minimal insulin with minimal carbs and when It's all over you ask why tthey didn't give you any proper guidance on what to do. Tto my mind they SHOULD
Hana

 

[hale710]

Hello :wave:

On Wednesday I am having an operation. I have to arrive at 12.30pm and the Op will be sometime in the afternoon. I can eat my breakfast and have a drink before 7.30am, and then if needed some water or very diluted juice before 11.30am, but then nothing at all. The doctor at the pre op assessment said not to take any insulin with my breakfast, but I said my blood sugar would be sky high if I did that, so after a bit of umming and arghing he suggested 3/4's of my normal insulin.

What concerns me is going without food and liquids for possibly a few hours and not going low and trying to keep a reasonable level. Has anyone got any good tips or advice about managing BS before an operation or have you had an afternoon operation. As it's now getting closer, I'm starting to feel a bit anxious and how did other people get through their ominous day ?

Thanks so much in advance

Best wishes RRB x

Hmmm tough one. Because if my diabetes I was put first on the list for surgery, so I was 8.30am. That meant I was fasting from midnight..... When I was asleep anyway.

The anaesthetist and I agreed on the way to control my insulin together. Did the doctor fully understand the regime you were on? Mine initially didnt realise MDI existed, he thought I was on mixed insulin so I had to explain it first

 

[robert72]

Hi RRB

Talk to the anaesthetist - they seem to be the ones that have the best knowledge of insulin. They will probably put you on sliding scale if your levels rocket.

Hope it all goes well for you :thumbup:

 

[robert72]

Forgot to add - it might be a good idea to take some gluten-free breakfast. That was the meal I had most trouble with in hospital.

Oops... missed the bit about going in at 12:30

 

[hale710]

On the sliding scale, they prefer not to use it if its avoidable and to let you take control yourself. My procedure only took one hour and since I had a steady BG readings in the lead up to it they opted out. It depends on the individual situations.

That's my experience from the hospital up here anyway!

 

[iHs]

Hi RRB

Hope it all goes ok for you on Tuesday....

Regarding your insulin.... I would think that you should be ok injecting the basal and then for breakfast, eat 2 fried or poached eggs, 2 rashers of back bacon, and 10g carb portion of gluten free baked beans (Heinz). You wont have to bolus for the eggs and bacon , only for the baked beans, that way you will fill ok appetite wise and wont feel hungry afterwards and your bg levels should also be ok. If you feel that your bg levels are going a bit low, you can just eat plain glucose tabs as they wont do anything to you while you have the sedation so you wont be sick or anything....

I had an op done in the afternoon and the above was what I did on the day although I did have a moan as to why insulin dependant diabetics are no longer operated on first thing in the morning like they used to do years ago so that diabetics could then inject and eat food and were ok without enduring high bg levels..... No answer Grrrr

 

[Robinredbreast]

Some years ago, my husband had a minor operation, which they did under a combination of sedation and local anaesthetic.
It meant he wasn't off his normal routine.
Can they do this for you?
Otherwise, with general anaesthetic, they usually apply a sliding scale drip routine.
I'd suggest, if you are in charge of your own control, you use minimal insulin with minimal carbs and when It's all over you ask why tthey didn't give you any proper guidance on what to do. Tto my mind they SHOULD
Hana

Thanks Hana

It's an eye operation under GA and the doctor said they do a lot of op's with patients have diabetes, so I suppose I will have to wait my turn :roll:

I only take a small amount of breakfast insulin 1 to 2 units depending on blood sugar and carbs, so I could take more of my gluten free cereal, or banana and small yogurt but just take 1 unit, I want to keep it between 7 and 10 if possible.

Doctors seem, to me, very compliance regarding diabetes in today's health care system and being type 1, I have no backup insulin to help me through.

Thanks for your advice

RRB

 

[Robinredbreast]

Hello :wave:

On Wednesday I am having an operation. I have to arrive at 12.30pm and the Op will be sometime in the afternoon. I can eat my breakfast and have a drink before 7.30am, and then if needed some water or very diluted juice before 11.30am, but then nothing at all. The doctor at the pre op assessment said not to take any insulin with my breakfast, but I said my blood sugar would be sky high if I did that, so after a bit of umming and arghing he suggested 3/4's of my normal insulin.

What concerns me is going without food and liquids for possibly a few hours and not going low and trying to keep a reasonable level. Has anyone got any good tips or advice about managing BS before an operation or have you had an afternoon operation. As it's now getting closer, I'm starting to feel a bit anxious and how did other people get through their ominous day ?

Thanks so much in advance

Best wishes RRB x

Hmmm tough one. Because if my diabetes I was put first on the list for surgery, so I was 8.30am. That meant I was fasting from midnight..... When I was asleep anyway.

The anaesthetist and I agreed on the way to control my insulin together. Did the doctor fully understand the regime you were on? Mine initially didnt realise MDI existed, he thought I was on mixed insulin so I had to explain it first

Thanks Hale I told doctor I am type 1 and gave my list of medications, including insulin, so he knew, well he should of known what I was talking about. I wish it was the hospital in my own town that I was having the op in, but Southampton is much larger and a teaching hospital, I will make sure they know it's the right eye.

Thanks

RRB

 

[Robinredbreast]

Hi RRB

Talk to the anaesthetist - they seem to be the ones that have the best knowledge of insulin. They will probably put you on sliding scale if your levels rocket.

Hope it all goes well for you :thumbup:

Thanks Robert, hoping to keep levels between 7 and 10, fingers crossed.

Thanks RRB

 

[hale710]

Hello :wave:

On Wednesday I am having an operation. I have to arrive at 12.30pm and the Op will be sometime in the afternoon. I can eat my breakfast and have a drink before 7.30am, and then if needed some water or very diluted juice before 11.30am, but then nothing at all. The doctor at the pre op assessment said not to take any insulin with my breakfast, but I said my blood sugar would be sky high if I did that, so after a bit of umming and arghing he suggested 3/4's of my normal insulin.

What concerns me is going without food and liquids for possibly a few hours and not going low and trying to keep a reasonable level. Has anyone got any good tips or advice about managing BS before an operation or have you had an afternoon operation. As it's now getting closer, I'm starting to feel a bit anxious and how did other people get through their ominous day ?

Thanks so much in advance

Best wishes RRB x

Hmmm tough one. Because if my diabetes I was put first on the list for surgery, so I was 8.30am. That meant I was fasting from midnight..... When I was asleep anyway.

The anaesthetist and I agreed on the way to control my insulin together. Did the doctor fully understand the regime you were on? Mine initially didnt realise MDI existed, he thought I was on mixed insulin so I had to explain it first

Thanks Hale I told doctor I am type 1 and gave my list of medications, including insulin, so he knew, well he should of known what I was talking about. I wish it was the hospital in my own town that I was having the op in, but Southampton is much larger and a teaching hospital, I will make sure they know it's the right eye.

Thanks

RRB

Maybe an arrow pointing to the correct eye will help

 

[noblehead]

I think it's sensible to reduce your breakfast dose slightly so that you don't go hypo later in the morning, once your admitted and waiting to go down to surgery they will monitor your bg regularly....... likewise when your in theatre.

ihs makes a good point about insulin dependant diabetics being first on the operating list, when I had my eye operation they had me down as first on the list for morning surgery ( I stayed in overnight on a sliding scale), might be a good idea to ring the hospital tomorrow and ask if you can be first on the list for the Wednesday afternoon surgery RRB, I'm almost certain the order of surgery won't have been compiled yet and they may put your name down first if you explain about your bg concerns.

Good luck and hope it all goes well!

 

[robert72]

Maybe an arrow pointing to the correct eye will help

Seriously, that's what they did on my cataract op. Make sure they wipe it off before you leave though

 

[Robinredbreast]

Hi RRB

Hope it all goes ok for you on Tuesday....

Regarding your insulin.... I would think that you should be ok injecting the basal and then for breakfast, eat 2 fried or poached eggs, 2 rashers of back bacon, and 10g carb portion of gluten free baked beans (Heinz). You wont have to bolus for the eggs and bacon , only for the baked beans, that way you will fill ok appetite wise and wont feel hungry afterwards and your bg levels should also be ok. If you feel that your bg levels are going a bit low, you can just eat plain glucose tabs as they wont do anything to you while you have the sedation so you wont be sick or anything....

I had an op done in the afternoon and the above was what I did on the day although I did have a moan as to why insulin dependant diabetics are no longer operated on first thing in the morning like they used to do years ago so that diabetics could then inject and eat food and were ok without enduring high bg levels..... No answer Grrrr

thanks I don't think I will be able to eat all that cooked food though, I know I wont have the stomach for it :sick: butterflies have started already. I didn't know of the plain glucose tablets, only the flavoured type, thanks for the info that's really useful.

Nowadays diabetes seems to be just run of the mill and not important enough to warrant any urgent or necessary adjustments for a stay in hospital with surgery, not like it used to be, that's not a moan, its just observation. I'm sure it will all be ok, fingers crossed x

Take care and thanks again

RRB

 

[Robinredbreast]

I think it's sensible to reduce your breakfast dose slightly so that you don't go hypo later in the morning, once your admitted and waiting to go down to surgery they will monitor your bg regularly....... likewise when your in theatre.

ihs makes a good point about insulin dependant diabetics being first on the operating list, when I had my eye operation they had me down as first on the list for morning surgery ( I stayed in overnight on a sliding scale), might be a good idea to ring the hospital tomorrow and ask if you can be first on the list for the Wednesday afternoon surgery RRB, I'm almost certain the order of surgery won't have been compiled yet and they may put your name down first if you explain about your bg concerns.

Good luck and hope it all goes well!

Hi I have already asked that question about could I be near the top of the surgery list because of getting home to my daughter, but nothing to do with actually having Type 1 diabetes, but they don't seem overly concerned. When The nurse was making sure I was fit enough to have the Op, my blood pressure was good, if a little lower than normal, 105 and my BS was 4.8 and she smiled and said I was one of the fitter ones she had recently seen, as a previous diabetic ( I wasn't told if they were male or female) had a BS reading of 20 :shock:

Thanks noblehead
RRB

 

[Morganator]

I had surgery at the beginning of June and because I am constantly high they started me on a sliding scale the night before. Unfortunatly I ended up in ICU because of an allergic reaction so was on the scale for a few days longer than expected :?

Sent from the Diabetes Forum App

 

[anna29]

Hi RRB .
Wrote you a long post reply yesterday and it vanished :x

Here is another one - I will be thinking of you tomorrow :wave:

Try writing a list of ALL the pre-op questions you would like to ask .
Then if your are too nervy to remember them - the list will re-jog memory :thumbup:

It is vitally important to get all sorted out pre-op .
With your aftercare plan with regards to diabetes control/management besides
your own wishes/choices being included in this .

I had my 'op' in march only 5months ago .
With using a Hospital Passport I had pre-filled in and taken in with me .
I was able to ensure my choices/wishes were implemented into my hospital care plan .

I was able to have my own named nurse [Natalie] she kept my glucose tablets on her .
To open them for me if needed .
She went down to the kitchen and collected my pre-ordered and chosen lunch diabetic friendly [egg salad]
Also used the staff kitchen to make me toast/real butter proper brew as soon as I returned
from theatre .
I wished to eat ASAP and administer my own insulin with Natalie's assistance .
I was one armed as the op was a left shoulder debride and tendon release .

The ward sister had to accept my wishes/own choices as they were clearly stated in
the Hospital Passport .
These are available from IDDT and are able to be kept by your bed for ALL hospital
and nursing staff to access/read .

The only thing that I couldn't do was use my own meter results to be documented in my notes .
It had to be the hospitals meter results only - that were recorded/documented !
This meter was vicious and left my fingertips sore and bruised I well remember
I could use my own meter as many times 'inbetween' as I wished though if I wanted .

Even my surgeon and anaesthetist read my Hospital Passport and agreed the best thing was
to let me do my own insulin self management .
I was allowed to be the 1st patient down so I could eat ASAP and give myself my insulin.
Natalie my own named nurse did everything for me including giving me my antibiotics IV
I requested this - as I always fall prey to any infections easily .
My surgeon agreed and signed this off also at my pre-op chat with him .

The time of pre-op discussions with any surgical/nursing staff it is vital to get ALL things discussed
and the right aftercare plan drawn up for you.
Ask ALL the questions and state your own wishes and choices clearly BEFORE the 'op'

Hope this can help .

Anna .x

 

[anna29]

Ask them to mark the eye that is being operated on .
This is a suggestion - just in case they DONT mark it 'pre-op'

If you are nervous - please say and tell them this fact .
They can be more aware of your needs this way :thumbup:

Maybe offer you a lovely nurse to simply hold your hand and chatter to you
I was offered a sadation plus the theatre head sister stayed with me throughout my 'op' too

I was awake whilst having my 'op' and yep it is scary as all the new technology and gadgets
are AMAZING !!!
I watched my 'op' on the screens :shock:

Anna .

 

[Robinredbreast]

I had surgery at the beginning of June and because I am constantly high they started me on a sliding scale the night before. Unfortunatly I ended up in ICU because of an allergic reaction so was on the scale for a few days longer than expected :?

Sent from the Diabetes Forum App

Hi Sorry to hear of your allergic reaction in hospital, it must of been worrying for you at the time. Hope you are keeping well and making good progress after the op

Best wishes RRB

 

[Robinredbreast]

Hi RRB .
Wrote you a long post reply yesterday and it vanished :x

Here is another one - I will be thinking of you tomorrow :wave:

Try writing a list of ALL the pre-op questions you would like to ask .
Then if your are too nervy to remember them - the list will re-jog memory :thumbup:

It is vitally important to get all sorted out pre-op .
With your aftercare plan with regards to diabetes control/management besides
your own wishes/choices being included in this .

I had my 'op' in march only 5months ago .
With using a Hospital Passport I had pre-filled in and taken in with me .
I was able to ensure my choices/wishes were implemented into my hospital care plan .

I was able to have my own named nurse [Natalie] she kept my glucose tablets on her .
To open them for me if needed .
She went down to the kitchen and collected my pre-ordered and chosen lunch diabetic friendly [egg salad]
Also used the staff kitchen to make me toast/real butter proper brew as soon as I returned
from theatre .
I wished to eat ASAP and administer my own insulin with Natalie's assistance .
I was one armed as the op was a left shoulder debride and tendon release .

The ward sister had to accept my wishes/own choices as they were clearly stated in
the Hospital Passport .
These are available from IDDT and are able to be kept by your bed for ALL hospital
and nursing staff to access/read .

The only thing that I couldn't do was use my own meter results to be documented in my notes .
It had to be the hospitals meter results only - that were recorded/documented !
This meter was vicious and left my fingertips sore and bruised I well remember
I could use my own meter as many times 'inbetween' as I wished though if I wanted .

Even my surgeon and anaesthetist read my Hospital Passport and agreed the best thing was
to let me do my own insulin self management .
I was allowed to be the 1st patient down so I could eat ASAP and give myself my insulin.
Natalie my own named nurse did everything for me including giving me my antibiotics IV
I requested this - as I always fall prey to any infections easily .
My surgeon agreed and signed this off also at my pre-op chat with him .

The time of pre-op discussions with any surgical/nursing staff it is vital to get ALL things discussed
and the right aftercare plan drawn up for you.
Ask ALL the questions and state your own wishes and choices clearly BEFORE the 'op'

Hope this can help .

Anna .x

Thank you for your very helpful posts , advice and support Anna x

I do have a Hospital Passport and I will take it. I'm sure it will go smoothly and quickly and I might even be out the same day, but saying that I would still have to go back the next morning for a post operative check, which would mean a train journey and a bus. Feeling very fidgety tonight and the butterflies are doing somersaults!

I didn't realise you were awake and watching your own Op on the screen, I just couldn't do that :sick: I know people find it fascinating, but er........no.

I will make sure I tell them which eye it is, the right one. I will do all my own medication, I can't see any reason why I couldn't or wouldn't be able to. I don't know what this hospital is like for patient care, but fingers crossed its a good one in the eye department.

Thank you ALL so much for your lovely advice and support X

Take care and best wishes

RRB