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> Having Surgery?, Any one had surgery with their pump on?
JohnG
post Feb 24 2009, 07:48 PM
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I,m having surgery on Thursday. They said to leave
my pump attached but the Surgeons are clueless. They looked at my sensor
and said it told the pump how much insulin to infuse. I asked if there was any
special instructions and they look at me (Like a deer in the head lights).

It's probably not a big deal.

JohnG


--------------------
John
T1-LADA 1988
Paradigm-530G/CGMS
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Dave_
post Feb 24 2009, 08:03 PM
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QUOTE(JohnG @ Feb 24 2009, 11:48 AM) *
I,m having surgery on Thursday. They said to leave
my pump attached but the Surgeons are clueless. They looked at my sensor
and said it told the pump how much insulin to infuse. I asked if there was any
special instructions and they look at me (Like a deer in the head lights).

It's probably not a big deal.

JohnG


I've had several surgeries with my pump on. Doctors like patients to run a bit high during surgery, so strive for about 160--NOT close to 100. That makes the anesthesiologist a bit antsy. If your bg falls outside safe parameters, you can be sure he will adjust your bg as necessary.


--------------------

Diagnosed T1 in 1978
MDI: 1978 -1996
Started pumping in '96 (MM 506)
MM523 (Blue Revel)
- My wife is a fellow pumper (Pink Revel)
Sets: Sure-T
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GA Hiker
post Feb 24 2009, 08:50 PM
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QUOTE(JohnG @ Feb 24 2009, 02:48 PM) *
I,m having surgery on Thursday. They said to leave
my pump attached but the Surgeons are clueless. They looked at my sensor
and said it told the pump how much insulin to infuse. I asked if there was any
special instructions and they look at me (Like a deer in the head lights).

It's probably not a big deal.

JohnG


I had minor surgery in December. My endocrinologist recommended I go into surgery with a BG greater than 100 (but I think it should be higher, at least 120), and that I set my basals down by 30% beginning 2-3 hours before surgery and continuing until I'm alert enough to set them back to normal. That worked well for me for that short procedure.

That said, I am not happy with the knowledge that exists in hospitals in general, and with surgery staff in particular, on how to care for folks with Type 1. I spoke with the anesthesiologist PA in advance of my surgery and she assured me that, "If your sugar's too low we'll give you glucose and if it's too high, at least over 200, we'll give you insulin." I asked her how she would know how much insulin I would need since she wasn't asking what my ratios were. She said, "Don't worry, if we give you too much, we'll give you more glucose." !!!! That does not give me a good feeling. I will probably be having a longer surgery in the next month and am sad to say that I am more concerned with the control of my glucose levels than with the surgery itself.

Two weeks ago, I had a short medical procedure in the hospital during which I was "out." When I was hooked up to the IV, I asked the nurse if it contained glucose and she said that it did. I explained that I had Type 1 diabetes, WHICH WAS IN MY CHART, OF COURSE, and refused the glucose. She swapped it for an IV without glucose.

Barbara
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JohnG
post Feb 24 2009, 10:31 PM
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QUOTE(GA Hiker @ Feb 24 2009, 02:50 PM) *
I had minor surgery in December. My endocrinologist recommended I go into surgery with a BG greater than 100 (but I think it should be higher, at least 120), and that I set my basals down by 30% beginning 2-3 hours before surgery and continuing until I'm alert enough to set them back to normal. That worked well for me for that short procedure.

That said, I am not happy with the knowledge that exists in hospitals in general, and with surgery staff in particular, on how to care for folks with Type 1. I spoke with the anesthesiologist PA in advance of my surgery and she assured me that, "If your sugar's too low we'll give you glucose and if it's too high, at least over 200, we'll give you insulin." I asked her how she would know how much insulin I would need since she wasn't asking what my ratios were. She said, "Don't worry, if we give you too much, we'll give you more glucose." !!!! That does not give me a good feeling. I will probably be having a longer surgery in the next month and am sad to say that I am more concerned with the control of my glucose levels than with the surgery itself.

Two weeks ago, I had a short medical procedure in the hospital during which I was "out." When I was hooked up to the IV, I asked the nurse if it contained glucose and she said that it did. I explained that I had Type 1 diabetes, WHICH WAS IN MY CHART, OF COURSE, and refused the glucose. She swapped it for an IV without glucose.

Barbara

Thanks' every one (That Makes sense)

Just a little story.

About 10 years ago I walked into an Emergency Room at a small community Hospital with kidney stones they checked me in and attached
me to a machine that pumped in Morphine. I was on MDI at the time and had nothing with me not even my meter by the time I could
regain some sort of stability they had me on a Glucose drip and had not been in touch with any of my Doctors. Buy this time my wife was having
a melt down she went to the house and got my test kit and insulin came back and checked my BG it was around 500 or 600 not sure my
old meter would just say Ketosis when the number was above 500. My wife finely convinced them I needed Insulin but they didn't know
what to do it was the next morning before they received orders from a Doctor to give me some insulin and would not let me do it
they said they could not trust me because of the Morphine but even then they would not give me any tell breakfast. For the next
3 days they dosed me on a sliding scale which was about 3-4 units per meal with Humalog and no lantus. At the time I was
using 20 units of lantus two times a day and my carb ratio was 3.5 using Novalog needless to say my BG never went below 250 during
my stay even when I refused to eat. Just had my wife take me home I told here I would just rather Die with my Boots on.

Just seams like I have to learn things the hard way

JohnG


--------------------
John
T1-LADA 1988
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gigem99
post Feb 24 2009, 11:09 PM
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QUOTE(JohnG @ Feb 24 2009, 12:48 PM) *
I,m having surgery on Thursday. They said to leave
my pump attached but the Surgeons are clueless. ...

It's probably not a big deal.

JohnG

The anesthesiologist is the one in control. I had asked to speak to mine the night before, and the head of the anesthesiology department called me that night - he sounded p*ssed for being bothered, and he gave me what I thought was bad advice, so I ignored him.

The morning of my surgery, my actual anesthesiologist came in, and I had written directions (in large letters, in crayola) for him. I showed him how to check my sensor readings, and how to suspend the pump, and how to disconnect in an emergency. He was a bright young guy, and got it. Just before going in, I tested (meter) and was 128. As soon as I woke up (3 hours later), I tested again and was 110. Perfect. My SG pretty much was right on target.

Good luck. It was painless for me, and I hope it is for you, too. Be sure to let us know how things went when you get home.

Tom


--------------------
Tom
Forum moderator
LADA - dx'd 1985 at age 31 - treated as type 2
Insulin therapy in 1987
mm 522 since Aug. 2007, cgms since Nov. 2007
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Linda B
post Feb 25 2009, 06:00 PM
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I left my pump on during a complete hysterectomy. My surgeon understood that the pump was customized to my requirements and that any other form of insulin would be less predictable. I believe you need your surgeon's permission, as well as the anesthetist.

I set up a basal pattern that was lower than my normal, in order to purposely 'run high'. I also changed my target on the bolus wizard to 150.
I was able to show the anesthesiologist how to use the bolus wizard when he came in to meet me pre-surgery.
Someone indeed used the bolus wizard to give me a correction while I was under.
When I woke in recovery I asked for a BG test, was around 200 and did another correction myself.

Linda


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Linda
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JohnG
post Feb 26 2009, 12:01 PM
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QUOTE(Linda B @ Feb 25 2009, 12:00 PM) *
I left my pump on during a complete hysterectomy. My surgeon understood that the pump was customized to my requirements and that any other form of insulin would be less predictable. I believe you need your surgeon's permission, as well as the anesthetist.

I set up a basal pattern that was lower than my normal, in order to purposely 'run high'. I also changed my target on the bolus wizard to 150.
I was able to show the anesthesiologist how to use the bolus wizard when he came in to meet me pre-surgery.
Someone indeed used the bolus wizard to give me a correction while I was under.
When I woke in recovery I asked for a BG test, was around 200 and did another correction myself.

Linda

My Endo E-mailed me instructions last night and coped the Surgeon and Anesthesiologist.
Basic instructions was to turn Basel down to 90% and tape every thing down good. Tell
every one in pre-op that I come in contact with I,m wearing a Insulin Pump apaantly
there has been some problems with infusen sets being disloged by nurses in pre-op. They
also sent a complete list of current settings for my pump and said not to do a Bolus unless
my BG goes above 200 and do not let it drop below 70. They asked me to try to get my
BG up to 120-140 in pre-op and if I have to, drink a small amount of apple Juce to get in to this range.

JohnG


--------------------
John
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Arlene S.
post Feb 26 2009, 03:40 PM
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QUOTE(gigem99 @ Feb 24 2009, 06:09 PM) *
The anesthesiologist is the one in control. I had asked to speak to mine the night before, and the head of the anesthesiology department called me that night - he sounded p*ssed for being bothered, and he gave me what I thought was bad advice, so I ignored him.

The morning of my surgery, my actual anesthesiologist came in, and I had written directions (in large letters, in crayola) for him. I showed him how to check my sensor readings, and how to suspend the pump, and how to disconnect in an emergency. He was a bright young guy, and got it. Just before going in, I tested (meter) and was 128. As soon as I woke up (3 hours later), I tested again and was 110. Perfect. My SG pretty much was right on target.

Good luck. It was painless for me, and I hope it is for you, too. Be sure to let us know how things went when you get home.

Tom


I had an excellent anesthesiologist and when I was in pre-op he and the rest of the OR staff gathered around me to learn about the pump and the CGMS. I had a spinal and I chose not to have any further sedation (this was for more than two hours of surgery for a trimalleolar fracture of my ankle). However, I was given the option of having some sedation if I wanted it during the surgery. So I showed the anesthesiologist how to use my pump and sensor.

When I called my endo to tell him about my ankle surgery he said, "Do not let them bully you into taking your pump off." Nobody even tried. They even let me wear my glasses so I could read my SG levels.

I have had colonoscopies and one endoscopy where I've been given propofol but I was out for about 10 to 20 minutes. The last anesthesiologist had me suspend my pump which I did because it was just for 10 minutes. I showed her how to restart it. I am just not happy about being put out for surgery or procedures.



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Arlene S.
Type 1
Pumped with Minimed 1993-2014
MM CGMS 2006-2014
Dexcom G4, June 2014
t:slim, June 2014
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JohnG
post Feb 27 2009, 12:16 PM
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Well ( not a big problem)

I made it through the surgery with out any problems with the pump or my blood sugar.
My BG going in was 117 and in about 1 1/2 hours after they started surgery it droped to 107
on my CGM looking back at the log file, about 4 1/2 hours later they checked me in recovery
and it was 124 on there meter. My Surgeon said She did not think the Anesthesiologist took any
intervention but was not 100% sure, if they did anything my pump was not used. The nursing
staff working in the O R said they looked at my CGM several times during the operation.
(They had never had the opportunity look at one before).

Note: Medtronic needs to make a plastic bag with operating instructions printed on it and a
big safety pin or velcro strap to attach it to the bed or clothing. Every one's first impression
was that the CGM fully automated the pump (Closed Loop). At first Look the Anesthesiologist
wanted to tun it off, they where afraid it we would Bolus on it's own but after I explained
that the system was not fully automated they felt comfortable letting it run the Basel
program and every thing was Cool.

Glad to have my Boots on agian
JohnG







--------------------
John
T1-LADA 1988
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