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[IP] Re: prednisolone [and surgery]

Hi Trish,

<part of original post>
<I was told in my consultation with the ophth. nurse not to take my
insulin the morning of the surgery.  No food or water after
midnight the night before, no breakfast, and no insulin.  I had already
explained the pump to her, briefly.  She told me I'd have to remove it.>

I'm sorry you have had to go through this.  Frankly, my worst memories
of my 35 years with diabetes have been fighting with medical personnel
who don't understand the diesease but think they do. I still remember
arguing against the glucose drip in one of my surgeries. They insisted,
and then bg level was over 800 when I was finished--but to get that
reading they had to ask me (who could hardly see with one eye, and the
surgery was on the other!) to do the finger stick, since they said a
blood sample would take an hour to process. I was incredibly sick (gen.
anesthesia, couldn't see, etc.), but was arguing that I needed insulin
NOW and to stop the glucose drip! They said they thought my bg was too
low (!!)--until I did the test (which I couldn't read). Even then, they
had to call my diabetic doctor before they'd stop the drip and
administer insulin. His advice to them was, "Do what he says!!"  Oh
my....  Somehow I survived, but it was no thanks to those dear folks...

Another time in the hospital for another eye surgery I was told that
they would have to confiscate my glucose tester--I couldn't do tests!
My wife thinks I got too adamant, but I simply said, fine...then I'm NOT
having the surgery! I told them to contact my doctor. They did, and of
course I was allowed to keep my tester. Amazing....

So enough of my anecdotes (and I have lots!). Here's what I suggest.

1) assuming your endo is supportive, have HIM help fight the battle.
They don't listen to us, but almost always listen to a doctor. Have him
call this person (or have her call him) and set her straight.

2) refuse to take off the pump during surgery. (tell them you will do it
only if your endo says it is a good idea....!) Try to explain to them
the difference between basal rates and boluses. [by the way, pre-pump, I
was told not to give any insulin for 24 hours before surgery. I simply
injected my ultralente (equivalent to the basal rate) prior to surgery
and ignored their advice. Of course I didn't give myself any humalog and
skipped breakfast, but that's all the adjustment I made.] Note: they are
legitimately concerned about bg levels dropping too low during surgery,
so it is right for them to aim a little bit higher than normal... but
complete suspension is ridiculous.

On the second matter:

<I finally read the ingredients on the other drops, most of which are
samples of various brands of artificial tears.  But one of them is
something called Econopred Plus 1% (Prednisolone Acetate 1%) Ophthalmic
Solution.  This is a steroid.  It sounds like a tiny amount, and it goes
in the eye, but nevertheless I want to know if it could affect my BG.
Does anyone have any experience with this stuff?>

I was told that it wouldn't have an effect on me. All I know is that the
combined effect of 1) stress, 2) the drops, and 3) physical inactivity
had me raising my insulin requirements by about 50%. So as always I'd be
prepared--go into battle mode (treat like an illness and monitor bg
levels more often) and I'm sure you'll do fine.

Again, I'd be happy to answer any other questions you may have re. the
surgery--either through the list or privately.

Good luck!


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