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Dear  Nancy:

I hope this gets to you before you go in to the hospital!  Wish I had seen it 
sooner....First of all, GOOD LUCK!!!  I know several people who in the last 5 
years have had brain tumors removed (and all were 100% successes, so we will 
all say what passes for prayers for you!!!)

As for the pump - here are some of the things I have written in the past, 
having had several i hospital adventures, including a laparotomy last 
year....it is ind of a mish mash and touches on a bunch of different 
areas...hope some of it helps!

I stayed on the pump for both a virrectomy and he laparotomy (which is where 
they slice you open from the middle of your stomah to below your navel and 
dig around to find out what is wrong with you...in my case it was an absessed 
appendix...I talked to the endo on duty (since i was in chicago) and to mine 
in NYC on the phone AND to the anesthesia guy who agreed to let me keep the 
pump.  taught him how to adminster a bolus, but ONLY if I went above 200, and 
we used a ratio of like 1 unit to 75 points (normal is 55-60 poins) just to 
make sure they didn't over correct.  i dont know if  he corrected anything 
cuz i came out a little over 200, but soon got myself back down as soon as 
the drug induced fog lifted a little.

"make sure you are at a comfortable bg level for the 2-3 hours before the 
surgery - check with your doc - probably 150-180 or so YMMV.  Since you will 
probably be fasting, make sure your basals are readjusted to 
compensate....meaning you may have to lower them the day before and just 
cover for highs - VERY  CONSERVATIVELY.  Don't over bolus for a high cuz you 
won't be able to eat anything to bring it up!  DONT FORGET the stress may 
make you go higher!!

HOW long will you be unconscious?  if more than a few hours, you should have 
a dextrose drip, NOT a saline drip.  Your body must have some sugar to work 
and if it doesn't you will go into  starvation ketosis.  Find out how soon 
you will be able to have juice of suck on dex tabs  - AND BRING THEM WITH YOU 
- they will not have them there.  

Will you have someone you trust to test and bolus for you while you are 
unconscious?  I trained my sister how to do it and got permission to let her 
in the recovery room after my vitrectomy - I was kinda out of it, but still 
did the poking and squeezing...she aimed the strip for my hanging drop...told 
me the number, then I told her how much to bolus...then I dropped back into 
blessed valium and demerol induced la la land)

Bring all your own supplies and tell the nurse what the reading are IF they 
ask (in my experience they only ask 3 times a day!!!), and IF they asked, 
told them how much insulin I bolused...they asked ONCE in a week I think.  
When they put me on glucose IV drip in the middle of the night without 
telling me and my sugars soared, they got a reaming by my endo for not 
telling me they had changed it - tee hee.

Make sure your diabetes doctor knows whats going on and he HAS to talk to 
your attending physician.  

OK, now - file this away:  In a 1 litre bag of D5% there are 180 calories - 
5% of that bag is pure dextrose - you can figure the CHO.  In the 1 litre bag 
of D2.5%, there are 85 calories.  This is the so-called sugar water they hook 
you up to on the IV.  Drexler ordered the D2.5, but they put on the D5 by 
mistake.  I hollered about being put on sugar water until DREXLER reminded me 
that your body needs APPROX 150 grams of CHO to function (YMMV).You need that 
much to keep from going into STARVATION KETOSIS.  Your blood sugars will read 
normal, or low, but check yer pee!!! Your body needs fuel and if you don't 
get it from CHO, you will get it the BAD way - fats and muscles etc. 

You have to figure out how much you are getting - Look at the flow rate on 
the IV machine - if it says 100 - that means you are getting 100ml per hour, 
so a 1 litre bag of IV  is gonna last ya 10 hours...If you are on D5%, you 
will get that 180 calories spread out over 10 hours.  If you are at 250 rate, 
you will get the whole 180 calories in 4 hours...and so forth.  THIS IS 

Then I had to drink the contrast stuff for the CT scan - they put it in Tang 
so it tastes less like shit and more like rotten orange juice, but they have 
NO CLUE how much tang is in it (one resident goes..."is there sugar in 
tang???")  So I drank it.  ALSO NOTE:  if you are having problems with your 
kidneys at all - DON'T LET THEM DO THE IV CONTRAST in the CT scan without 
talking to your diabetes doctor.  The stuff you drink makes the test a little 
less telling, but the stuff they shoot you up with is BAD for the kidneys.

well...i cant think of anything else

good luck nancy

Love sara
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