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Re: [IP] Surgery


I had a cataract removed last year, while wearing my pump, using Humalog.
Prior to surgery, I was chastised on another list for my planned use of a
temporary basal reduction during the surgery. That argument went along the
lines of  "If your basals are set properly, you should not need to change
anything", etc. In theory, yes .....

For over 41 years I have experienced random, rapid and dramatic drops in my
BG. This has greatly diminished with pumping, but every so often I still
experience this. There is not always a logical reason, nor are these events
always predictable :-(

In my case, my DM doc was more comfortable with my plan for a temp basal
reduction than he was with maintaining my normal basal rate, due to my
history (although he did let me plan the amount of the reduction). My doc
was also in agreement with the anesthesiologist's plan to use a Dextrose
IV. I was a bit uncomfortable with the plan for the IV, but did not have my
act together enough to realize that IVs can be done without Dextrose, or
with a different concentration of Dextrose. As it was explained to me, "You
*do not* want to go low when they are cutting into your eye". I could not
argue with that logic and I agreed to the Dextrose IV.

Pre surgery, I did take the opportunity to do pump training for the
attending nurse. I explained to her how the pump worked, how to disconnect
the quick release if needed, etc. I was allowed to check my own BG, report
the results, etc. This I would *not* compromise on. Either the nurse
attended my training, or I was not going in ;-) I was pleasantly surprised
by her reaction - she obviously felt much more comfortable, knowing how to
work things and knowing that I knew so much about my care.

Pre surgery my BG was 110, after surgery it was 250. Elapsed time was about
1 hour total. Well we know that the Dextrose IV worked ... ;-)

One lesson I learned from this experience is that the planning process for
surgery needs to be taken care of well in advance, even for outpatient
surgery. If I had started planning sooner, I may have handled pumping
differently than I did. The important thing is to make sure you have
thorough discussions with all those involved in your surgery and "after
care". You need to feel comfortable with the plan of action and how you
will be allowed to manage your diabetes. If I was not comfortable with all
aspects of the plan, I would not proceed until I felt confident that all
the details were correct.

One of the benefits of outpatient surgery (as I understand it) is that the
procedures are often not due to a life threatening situation. If something
needs to be delayed, it may be re scheduled without major problems (I
realize there may be exceptions to this).

Emergency surgery is another matter altogether, as Sara and others can
attest to. I don't know how we can guarantee that we each maintain
ownership of our DM / pumping control procedures in these emergency
situations - this still stumps me. I want to put an "action plan" in place,
yet am uncertain about how to do this.

I do know this - pumping makes this whole thing easier for me ;-)

Bob Burnett

mailto:email @ redacted
Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/