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Surgery and diabetes

Discussion in 'Parents of Children with Type 1' started by StacyMM, Jul 8, 2011.

  1. StacyMM

    StacyMM Approved members

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    Hi, everyone!

    DD is getting her tonsils removed next month. We're having it done at the local children's hospital since our endo's office is there. Figure it never hurts to have an 'expert' on hand in case I disagree with a nurse/doc about diabetes management post-surgery. ;) We have the first appointment in the morning and she's scheduled to stay overnight after the surgery. I asked the surgeon about monitoring/maintenance during surgery and he believes the anesthesiologist will have us remove her pump. It sounds like her numbers will be checked pre-surgery and post-surgery but not during.

    Looking for BTDT advice - Basal changes that have worked during/after surgery? Are most hospitals fairly accomodating at allowing us to monitor/treat her diabetes or are they usually involved? Is pump removal fairly standard? Anything we should know going in? We'll talk to the anesthesiologist that day, as well as the nurses and surgeon but I always like to be prepared.

    My son has had several surgeries so we're familiar with processes and such - it's the diabetes that will be different for us.

    Thanks!
     
  2. momof2here

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    best wishes for a quick recovery!

    I am sorry that I do not know the answer to your question but just wanted to chime in and wish your daughter well during surgery and recovery!

    It is a great question though and I know you will get lots of excellent advise that we can all benefit from!
     
  3. timsma

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    My son had his tonsils removed when he was in middle school. We weren't at a hospital that was connected with his endo though unfortunately. They did keep his pump attached. I highly recommend them not removing it! He started out with a great blood sugar, in the low to mid 100's, but after it, due to the stress on the body, he was high and had large ketones. He is one that develops ketones easily though, so not sure if your daughter does. Anyway, they didn't automatically expect him to spend the night in the hospital, it depended on if he was able to eat, drink, keep things down. He couldn't, so did spend the night. Know your carb counts of various foods going into this, as there was NOBODY that had a clue to carb counts of different foods for us. I had a good idea of them, but expected them to know them as well, but they were all clueless, as was the kitchen staff, dieticians. He slept for a very long time after the surgery (also had his adnoids removed) and was very sore for a few days. I did keep in contact with his endo, but since she didn't have 'privileges' at this hospital, the docs there couldn't take orders from her. I found it to be a frustrating experience, but he survived, lol! I wish you both the best!!! I handled all of his D care while in there, and the staff was actually grateful! Oh, it was a fairly short surgery (about an hour tops). They also did a blood sugar check during surgery they said, as well as before, and after. I understand the anxiety about the D care, and frankly, if I were you, I'd tell them that I would handle it, and they are normally very happy about that. Your experience might be different of course.
     
    Last edited: Jul 8, 2011
  4. ChristineJ

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    I would recommend speaking to both the surgeon and the anesthesiology team, prior to the surgery, about your son's diabetes and their plans for care during and after surgery. My son had his tonsils and adenoids out in February. Although they knew he had diabetes, anesthesia didn't tell me that part of their "routine" is to give a dose of dexamethasone (a steroid) during the procedure. My son's BG spiked to 328 and I had no idea why. I finally figured it out when I called the recovery unit the next morning and asked some ????'s. You might try a search here on CWD for "tonsils" and/or "surgery" too. There are several threads that were helpful. Good luck!:)

    Christine
     
  5. kgerrick

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    I am not an expert but I don't like the fact that they are not checking blood sugar during surgery. Don't they check blood pressure during surgery? So why not check blood sugars too? I wish your son a speedy surgery and recovery!! Best wishes to you!
     
  6. swimmom

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    Lauren had her adenoids removed. The surgery and post-op was fine (the docs and surgical nurses monitored her and took good care of her). It's a quick surgery.

    The recovery in the regular hospital room was a problem. She physically did fine, but even in our local Children's Hospital, the nurses were clueless. We asked to be in the diabetes sections, but it was either full or they ignored the request. Since they took good care of her after diagnosis, I assumed they would do so again. The food they brought her was nasty (Type 2 D hospital food I guess). She likes sugar free jello and pudding, but the hospital stuff was disgusting (even though in the diabetic area they had the good stuff, we couldn't get them to being it to her room). I had to get my husband to go to the store to get something she would eat.

    Bring all your own D supplies. The lancets were from the dark ages and the the syringes looked like something used by a large animal vet. Again, not the same care we had received in the same hospital post-diagnosis. Once I had my supplies though, the nurses were more than happy to let me take care of her D needs.
     
  7. timsma

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    I remember also bringing Tim food from home. Made a special trip back to do so as they didn't have anything he would eat either. I agree to bring your own supplies as well. They were very happy to have us manage his D while there too. And had they wanted to do so? I wouldn't have ever let them!
     
  8. LJM

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    Carter had knee surgery last Labor Day. Since they were using electrocautery we had to remove his pump (per the Animas Manual). Otherwise they would have preferred to have it on. The Anesthesiologist will be in charge of monitoring BG and ours wanted to make sure that we kept his BG down so that healing would be maximized post surgery.

    We checked him right before surgery and gave a small bolus as he was trending higher. The nurse disconnected him and left his pump run in the surgery room away from the equipment. He was connected immediately after and sent to recovery. He stayed steady until he awoke and then had a small low which we were able to treat (since it was knee---not throat like you are dealing with). They had dextrose available but used a sugar free IV solution during surgery (that was standard).

    In recover I did all the monitoring of blood sugars and treated any lows. We totally lucked out and had a Type 1 nurse in the recovery room.

    Just be there and watch and ask questions; don't assume that anyone there will know anything about diabetes----
     
  9. TheFormerLantusFiend

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    I've been under general anesthesia three times with diabetes, once for a surgery and twice for endoscopies. The only one of those in which the anesthesiologist actually checked my blood sugar was one of the endoscopies, in which I had something of a crisis in the middle and ended up being unconscious a lot longer than expected.
    Anyways, the stress and excitement at those times has pushed my blood sugar a little high but nothing I couldn't handle.

    Some hospitals have a policy of making patients remove pumps, others don't. At the hospital I go to, the residents and nurses keep asking me why I'm not on a pump :rolleyes:. A few studies have shown that patients do better when they keep their pumps on in the hospital, and I would argue against switching to some other insulin system.
     
  10. StillMamamia

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    I would ask your endo to get in contact with the surgeon and anestheologist, and have them discuss the best way to deal with the BGs.

    My son had surgery last year to remove a thyroglossal duct cyst and removal of the thyroglossal duct and he kept the pump on. We were given an "ideal" BG range pre-surgery, but we were under that, but surgery took place nonetheless. It's a good thing if your child is one of the first into surgery. I just played with the temp basals overnight pre-surgery, then post-surgery.

    They did check BGs during surgery and they knew what to do, and all went well.

    I really think if you can get the endo to have a word with the surgery team, it will make things easier and give you some peace of mind.

    Hope all goes well.
     
  11. Charliesmom

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    Charlie had his adenoid removed and tubes put in his ears in January. He kept his pump on during surgery. They checked his blood sugar before and right after. He was originally scheduled for an 11am surgery but the endo wanted an earlier appointment so it was changed to 830am. The ENT figured the Endo would want him to have an overnight stay but the Endo didn't think it was necessary. We were home before lunch. We did end up needing to increase his basal by 90% for about 5 days after the surgery. Other than that he was bouncing around the afternoon of the surgery. I had some of the Pedialite ice pops to help keep him hydrated.
     
  12. StacyMM

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    That's a great idea! I need to figure out some soft carbs and have them ready, just in case we run into lows. When she gets sick she tends to go really low and my biggest worry is her not wanting to eat.

    Thanks for the info on the pump management. I really like that approach! And I never thought about the carbs in IV solution. I'm adding that to my list of questions!

    Good idea. I don't have an appointment before the surgery but I'll put in a call this week and ask for a call.

    Love to hear about the recovery!! I think DD will be disappointed if she doesn't get to stay. Her brother has had a few overnights with his surgeries and she's just in awe of that and wants to stay just because of that. :p
     
  13. StacyMM

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    Something else I never knew!! Thanks for the info - adding it to my list...

    I never thought about that. I wonder if the endo floor would be an option for us! And I'm definitely bringing foods! I am amazed by hospital lancets. There are so many better options out there and ours still uses the huge ones, too. I always ask to use ours and I've been happy because they've always agreed. I think the nurses hate those lancets as much as we do. ;)

    I've heard that before - I think in a discussion on pregnancy and diabetes and dealing with delivery. It made so much sense to me when I read it but I had completely forgotten about it. Thanks for the reminder!

    And, everyone, thanks for the well wishes :) I really appreciate your help!
     
  14. Ali

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    I hate to say it but you need to talk with all the major players. I had talked to the admit several days ahead about what I needed, I then talked to the nurses upon start of surgery and the Docs. When I awoke from surgery my pump was detached, in scrubbing me (I guess???) they disconnected and it was gone. I awoke in post op high with no one checking sugars and no syringes or pump supplies-it was a day surgery. This was unbelievable to me. I am an adult, my Endo worked at the clinic connected to the hospital. I wrote a letter of complaint after being released, no response. This was a large well respected Hospital. All I can suggest is too not follow the Hospitals standard routine pre admit but call your endo and ask them to work directly with all members of the surgical team and all post op people. Good luck. Ali
     
  15. arogers

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    My son had his appendix out last year, obviously an emergency surgery. He is on the Omnipod and the surgeon was amazed at the "new" insulin pumps. No one had any idea how to work anything, so I signed something taking responsibility for his diabetes care. We checked his BG before going into surgery, did a temp basal decrease of 60% (just a guess) and checked 45 min later when he came out. Everything was fine. When the nurses came in overnight to check his vitals, they just asked what his bg was and recorded it. My son didn't want to eat (I'm sure it will be worse with tonsils) so we just used regular drinks and temp basals and everything was fine.

    Mom to 3 boys
    15, 13 (dx 3/07 Omnipod 10/07) and 8
     

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