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RE: [IP] Questions on Managing BG and Surgery



Hi Carol,

Cervical fusion? I am sorry to hear that -- it is unpleasant to
undergo.

 > So, what do I do now?

First, you need to have a sit-down with the anaesthesiologist. You
will get a chance just before your surgery, but ideally you will
make an appointment before that, and ideally you will show up with
a proposal that doesn't leave him worried about additional risks.

That proposal would include a 30-second course on how to take off
the pump in case of need; an explanation on how the pump
essentially implements a basal/bolus regimen, and that your basals
keep your BG stable absent outside influences; and an agreement to
reduce your basals pre-op by 30% to 50%. Also: Wear the infusion
set low, no higher than the lower half of your abdomen; do not
wear any thigh- or arm-bands, pump holsters, or the like -- just
tuck it under the pad on the table; and before you get your
diprivan (that's what puts you under in five seconds, a
milky-white substance with the technical name, among
anaesthesiologists, of "The White Stuff" :-) ), be sure to
demonstrate unhooking the pump.

But the actual surgery is probably not a worry: You will be hooked
up to a bag of IV fluid, and using D5W and adding the occasional
shot of insulin is not rocket science. Besides, a few hours of a
BG of 200 mg/dl are not going to do measurable damage.

So you are right to worry more about the post-op period, when you
no longer are under the immediate care of a specialist who is
there just for you and only for you.

 > I just don't know what to do about
 > the time I'm in the OR and recovery.

You cannot do anything about the recovery period, which is why it
is vital to come to an understanding with your anaesthesiologist.
It is also important that your anaesthesiologist feel comfortable
with your understanding and treatment of diabetes. For instance,
if you go low during surgery (remember the lowered basal?) that
pump will come off quicker than you can say "hypoglycaemia",
because a few hours of moderately high BG haven't killed anyone
yet, while a low is an acute condition. So, make it easy for them
to let you handle your own BG management.

 > (Now that I think about it, I'll be under
 > the influence of some heavy duty pain
 > medications for a few days.  How do I
 > handle that?)

You do not. Go easy on the meds, if you can; if you cannot, it is
better to get crappy BG management from the nursing staff than
killing yourself in a drug-induced haze. As for your husband
driving the pump, if I were the hospital, I would not agree to
that -- while you were incapacitated, I would insist on hospital
staff taking management decisions. After all, hubby won't get sued
if things go pear-shaped.

 > I've been told that I cannot wear my pump
 > in the OR (something about an instrument
 > used to cauterize blood vessels and electrical
 > current).

Impress your surgeon -- the instrument is called the
electrocautery, or just the "Bovie" (like a "Xerox" stands for a
copier).

People using Bovies generally dislike conducting things, because
they make the current travel a different route -- instead of going
from the Bovie tip to the large electrode they'll attach to your
arm or leg, it may go through the surgeon. :-)

However, your pump is not made of conductive material. (Caution: I
do not know of the Dana and Nipro devices.) The worst that might
possibly happen is that the Bovie ruins the infusion line --
unlikely because (a) if the line gets into the sterile field, they
did something badly wrong; and (b) you will of course do your part
to keep the pump out of the way.

 > I just don't want some over-zealous nurse
 > checking my BG and giving me insulin
 > without my active participation.

Realistically, you may not have a choice. You can refuse
treatment, but if you try to refuse BG management while you are
incapacitated, the surgical staff may refuse to operate. Your best
bet is cooperation, helpfulness, education -- and "please" usually
works better than "I demand".

Good luck, and best wishes for your speedy recovery --
Felix.
.
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