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Being put under with anesthesia

Discussion in 'Parents of Children with Type 1' started by mikegl31, Nov 28, 2016.

  1. mikegl31

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    My 7 year old is have a little procedure next Friday and will be put under anesthesia for about 30 minutes. He can't eat after midnight. Has anybody had any experiences with this? I have a call into my endo just to run it by them to see what they have to say. I assume the safe route will be to run him a bit higher over night leading into the procedure - but I don't want him running too hight either. He wears a pump and CGM. The CGM should definitely come in handy during the procedure. Thanks in advance.
     
  2. mocha

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    When I had my wisdom teeth removed, the non-endo-dr's office said to not eat for 12 hours before and not to take any insulin for 24 hours before (cue eye roll here). I was on an insulin pump at this point, but didn't have a CGM. Murphey's Law made an appearance, so I did go low the night before (I think it was in the mid 60's? This was almost 10 years ago.). Instead of eating 15 grams and waiting 15 minutes, I did 1 glucose tab at a time and waited the 15 minutes (and repeated until I was over my normal target (normally target 100)). I targeted about 30-50 points over my normal target (so I tried to stay between 130 and 150), and we disconnected my insulin pump as we arrived for the procedure.

    I have a horrible time with being put under, and end up throwing up for at least 48 hours afterwards (which makes management difficult). If this ends up being the case, I highly recommend liquid Benadryl. I'm not entirely sure why it works, but it stops the puking.
     
  3. mikegl31

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    Thanks Kristen.

    No insulin for 24 hours before...no thank you. I'm really hoping the after effects are minimal to none. We have been to the ER twice in the last 2.5 years because of vomiting. I'm still waiting for the endo to call me back. Curious to see what they have to say.
     
  4. rgcainmd

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    I highly recommend Zofran (Ondansetron) for vomiting. Benadryl has anticholinergic side effects and not worth the risk.
     
  5. Snowflake

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    My T1 daughter has had anesthesia twice, once for endoscopy, once for tonsillectomy.

    The big thing is to request the first appointment of the day, which at many hospitals is 6 a.m. That will shorten the fasting time for T1 management. It's been awhile, but I think our instructions were no solids after dinner, and then clear liquids were ok till 3 or 4 hours before surgery. After that point, which was something like 3 a.m., we reduced her basals to lessen the chance of her going low and then we stayed up obsessively monitoring the dexcom. We also had to keep her under a high-side threshold for the tonsil surgery (it was pretty generous -- 250 or 300?) or the surgeon wouldn't operate, so we were careful not to overdo the basal reduction.

    I would definitely make sure that the endo is talking to the anesthesia and surgery team. Good luck!
     
  6. Cheetah-cub

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    My advice is the same as Snowflake's.

    My daughter had the anesthesia for her endoscopy. Our endo team worked with our G.I. team. My daughter was instructed to have the earliest appointment of the day, and she did. Our endo team also helped us with our insulin setting to ran her bg a bit higher, because after midnight, we were not allowed to feed her even juice. We were told that if we had to feed her in the middle of the night, we would have to reschedule the procedure. Luckily it all went smoothly for us, although I remembered that I was stressed out all night.
     
  7. MomofSweetOne

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    One week to go here; I'll be glad when it's over, but I know the diabetes management is going to be a challenge for a couple of weeks. Having no straws allowed is going to complicate night feedings. Our orders say to suspend the pump. If she gets to 60, then I'm supposed to use one juice box but not tell the surgeon per endo. I intend to have the Dexcom set to 100 for lows and do a temp basal to boost her slightly higher if needed rather than get anywhere near 60. Our endo said to expect her to climb throughout the night before due to stress and to correct repeatedly, that I probably won't get much sleep. A 200 cancels surgery due to higher infection risk. We have the first surgery of the a.m.

    Our endo made sure both we and the surgeon know they can be reached at anytime that morning.
     
  8. mwstock

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    The summer before last my son had a freak bike accident. We were out on a family bike ride. The accident happened around 7:30 p.m., and he was transported by an ambulance to the ER, where he was in one of the trauma beds. He nearly missed a femoral artery during the accident. We checked his blood sugar, and gave glucose while we were waiting for the ambulance and fire to arrive. We held pressure on the bleed before the ambulance arrived. He went into surgery around midnight. I recall us just checking blood sugar before he went into surgery. I want to say he was in surgery about one to two hours. His blood sugar was elevated because the trauma. I checked periodically while we were in the ER before the surgery, and gave corrections or ran a temp basal. The wound was infected and he had to go through the surgery a second time. The time was nearly identical. He had to go through about three to four weeks of wound care, with a wound vac. He was in the hospital for around four days each time. I would try to keep the blood sugar in a target range. You could use the temp basal function on the pump, or give corrections for high blood sugars. The doctors allowed us to manage the diabetes while he was in the hospital, and we checked him prior to surgery. He kept his insulin pump on through the whole experience. The only time he had to remove the pump was in the ER. The trauma doctor did not want any insulin going in him, while they were doing the trauma exam. That was a short period, so I was able to reattach the pump after a 20-30 minute disconnect. The overall experience was very challenging, but we managed to pull of a decent A1C, despite the trauma and hospital stays!
     
  9. MomofSweetOne

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    Just wanted to say that things went well after being so anxious beforehand. One word of advise I'd post for others facing surgery is that I wish we'd talked more together in advance more about what nothing by mouth after midnight meant with diabetes vs. non-diabetes. My mental plan was no IOB by midnight and suggested eating around 5 so that the extended bolus was worn off. She had heard the dr. say eating was ok until midnight, so she declined at that point, expecting to eat later. I didn't realize she wasn't thinking about IOB and its difficulty during a period when my only option for treating lows was temp basaling.

    Our basal settings were incredibly accurate and we slept through the night, despite our endo predicting I would be up most of the night. I wish I could replicate that night.

    She slept in leggings and a t-shirt. I'd been warned by a CDE that one kid she worked with had been in beautiful range spiked to 375 with nerves and the surgeon cancelled. I didn't want that to happen, so we opted that she would roll out of bed and leave immediately.

    She spiked to 190 during surgery. I corrected her immediately in recovery, and she came back down immediately. Since then, she's needed 20% more insulin, but management hasn't been as awful as I'd thought it might be. I'll be glad, though, when the diet is more than ice cream with its challenges and spikes!
     
  10. rgcainmd

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    Happy to hear that things went fairly well, and I hope your daughter feels like her old self in no time!
     

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