Surgery, Type 1 and You

A recent surgery taught me a lot about how to manage Type 1 diabetes while in the hospital. Before the surgery I contacted my Certified Diabetes Educator (CDE) for advice about how to adjust my basal rate for the procedure. The surgery was scheduled to take about 3 to 4 hours and was scheduled for 12:30 in the afternoon. The CDE consulted with my Endocrinologist and suggested that since I would not be eating for nearly twelve hours prior to the procedure, that I reduce my basal by 30% the night before and 50% during surgery. This sounded reasonable to me considering I would have no food intake for a long time, so I did that. My fasting sugar upon entering the hospital was 190 on my Blood Glucose Monitor and steady, according to my Continuous Glucose Monitor (CGM). I checked into the hospital and went to the pre-op area. My surgeon wanted me to check into pre-op an hour early so that I could meet with the Chief of Diabetes Care in the pre-op area. Part of me felt this was unnecessary since I had already consulted with my team. I am very happy with my diabetes care team and they, along with me, have helped me to keep my A1C to a respectable 6.5 over many years. I felt good about the advice I had received and thought a meeting about my diabetes with a doctor I did not know was unnecessary. This additional pre-op meeting was invaluable, however and I would insist on this if I ever need to have surgery again.
This doctor reversed what my team had recommended. His thoughts were that since surgery introduces a lot of stress on my system my Blood Sugar would rise significantly during surgery. He suggested raising my basal rate by 50% for 6 hours. He grabbed my pump and when he saw that I have nearly 12 different basal rates throughout the day, he declared that I had too many basal rates. This doctor had a kind of enjoyable, yet wild, bedside manner and was a bit too cavalier about grabbing my pump and attempting to change my programmed basal rates to reflect his suggested temporary basal rate change. The last thing I needed, or wanted, was for my meticulously figured basal rates to be changed and then I would have to write them all down and re-program the pump after surgery. I was getting a little nervous about how he was going about achieving his recommendations even though I understood what he was saying and, to be honest, agreed. I was hesitant, to say the least. I persuaded him to give me my pump back so I could properly program the temporary basal to implement his strategy. Since I had put in the temporary basal with his advice I now felt more at ease and we had a great conversation about how the diligence of good diabetes control has lasting positive results.
A few minutes later the anesthesiologist came in to find out how and why I was going to keep my pump on during surgery. He was skeptical that this was a wise plan. I learned, at this point, that patients are normally required to remove their pumps and leave all diabetes control during surgery to the anesthesiologist. The anesthesiologist had never seen a Continuous Glucose Monitor before. While I was quite surprised at this, he was intrigued. In our conversation he learned that I was in excellent control and had a minute to minute knowledge of what my glucose readings were, where they were going and how to manage them. He was persuaded to allow me to keep my pump on and give the CGM to him during surgery. He would monitor my glucose pattern on the CGM and adjust glucose as needed. We then made a plan for him to immediately return my CGM to my wife once the procedure had concluded. He was concerned that I have this device as soon as I was awake and could resume my own care. The anesthesiologist restored my confidence and made me feel that this team was working with me in the best possible way. His enthusiasm and interest in my pump and CGM was refreshing. He was totally into working with me when he learned how he could incorporate the CGM and pump into his regimen. I showed him how to suspend the pump should my sugar dip too low and he assured me he could administer glucose should that happen. He also promised me that should my sugar rise too high he would administer insulin. I was relieved.
The anesthesiologist was sold. He loved the ability to watch my glucose readings on my CGM during surgery. Surgery went well and my glucose hovered around 200 for the entire procedure. Diabetes was never once an impediment to the procedure and all doctors and nurses were rather impressed with my control and the ease of monitoring a person with the tools to maintain well controlled diabetes during surgery.
Recovery went well and the only negative issue I had was the following day after I treated a dipping blood sugar with the small container of OJ left at my bedside. This was also after I had eaten the banana and glucose tablets I had brought with me. I asked the nurse supervisor for another container of OJ to have on hand and she said OK and went away. She never came back. About an hour and a half later she stuck her head in my room again and I reminded her of my need for OJ. She said, “Oh right, you wanted some juice.” I am sure she thought I just wanted some orange juice not that I needed juice close by at all times. I said, with a bit of an attitude, I must admit, “this is a medical necessity, not a whim of desire because I feel like some juice.” About 15 minutes later another nurse returned with my container of OJ which, by now, I needed, so I had to ask for another one! I do find a bit of a lackadaisical attitude toward people with diabetes in the hospital, in general. Perhaps the nurses and staff view it as a nuisance since symptoms are easily dealt with and dismissed. I don’t know what it is about diabetes but there always seems to be an, “that’s not so bad” attitude toward this condition. Anyone who deals with blood sugar control 24 hours a day, 7 days a week, 365 days a year knows how bad it can be. The people that do not take our condition seriously are the ones I always strive to teach in as nice a way as I can considering how annoyed I usually am when these people display their ignorance to me!
The lessons I learned from this hospital stay were priceless. I’ve always known that I am the most knowledgeable about my diabetes. That is one thing that the Chief of Diabetes Care was quick to recognize and that is probably the acknowledgement that brought me into his confidence. It has become crystal clear to me that the way to get the best care in a hospital situation is to insist on it. Insist that you know the most about your condition. Insist that the medical professionals count you as a member of their medical team in caring for you. Engage yourself with every aspect of the reasons you are there in the hospital. Do not let less then great staff members get away with being less than the best they can be for you. If they don’t step up ask their supervisor for them to step down from caring for you and get another staff member to take their place. They will do it. Hospital stays are extremely expensive and you have the right for the best care they can give you. Insist on it. The life you save may be your own!