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[IP] Inexperienced and Scared
> I have been on..pump since March 1999 and I am far from being
> an expert. I'm scheduled for surgery in 10 days and my concern is
> dealing with the fact that the surgery is being performed at a VA
> hospital where there are no doctors or staff that are familiar with the
> insulin pump.
First of all, I bet you would be hard pressed to find ANY hospital where the
doctors or staff are familiar, let alone comfortable with the pump. In this
regard, YOU are the expert, so it will be up to you, and hopefully your endo,
to TRAIN those who will be responsible for your life. It takes a little more
effort and time, but the control you CAN maintain, is WELL worth it, and the
better your control during and after surgery is vital to your subsequent
recovery...BEEN THERE DONE THAT, GOT THE SCAR!!
> recent posts....has increased my uneasiness about all of this.
better to be prepared...don't be worried - just take advantage of the days
you have left to insure you are comfortable once that anesthesia starts
> How should my wife or I handle the staff regarding their ignorance of
> this device?
Call your attending, who will be covering you while you are there....go over
everything with him, and get written approval from your endo - keep a copy of
this with you at all times. Also, fin dout who your anesthesia dude will
be...sit down with him and give him pumping 101...show him how to deliver a
bolus, and how to suspend, and that is ALL. Give him written instuctions on
what to do while you are unconscious...Discuss the bg range you will be
shooting for....it is suggested you do NOT aim for 80-120 during
this...better to aim, say 140-200...WRITE down what if any, correction should
be given, ie "if my bg is 140-200 do nothing. if my bg is 200-250 administer
X units" and BE CONSERVATIVE with this bolus...better to be a little high
then even slightly low....
> doctor instructions that I remain on the pump but I don't know if they
> will honor my request.
get it in writing and they have to. You may have to sign a release. How
long are you gonna be in surgery? how long before you can sanely monitor
your own levels> If your wife or a family member plans on staying for the
duration, train them how to do a finger stick, and give them the same bolus
instructions as you do the anesthesia guy.
Read my previous post entitled HOSPITALIZATION, or one from last FEb called
Hospital 101 as to how to deal with the IV fluids...if you are NOT going to
be eating fr a while, you WANT IV glucose...just be aware of what
concentration and flow rate
TAKE ALL YOUR OWN equipment and dex tabs. I can virtually promise you that
the hospital will not have anything you need, INCLUDING insulin. Test
whenever YOU feel like, and often is better.
Stress may raise your basal needs...test OFTEN the 12-20 hours before your
actual surgery...lower your basals or put in temps
It CAN be scary, and you MAY feel like your care is gonna be compromised by
the fools who are in charge of your life, but KNOWLEDGE is power. Even if
you are unconscious, make sure you have someone ther who isn't!!!! I fought,
and got permisison to have my sister in recovery with me following my
vitrectomy. I did the finger poke, and she aimed the strip at my hanging
drop...then i walked her through delivering a bolus. Even after my more
vigourous laparotomy, i had my aunt there telling me what my bg was and me
slurring out what amount of a bolus I needed...
> Is this really something I should worry about?
yes, but NO...if you are prepared. I fear beng run over by a truck not cuz
I wear holey underwear, but if Iam knocked out and can't tell anyone how to
take care of me!!!! I am not normally a control freak, but when it comes to
my diabetes, I think i'd rather be dead than take my chances with stupid
doctors and EMTs
> he doctor told me that they give diabetics glucose prior to surgery
> to keep them high so they won't bottom out.
tell him you don't mind an IV drip of dextrose, but you MUST know the
concentration and the rate so you can adjust your basal rate. you do NOT
need a huge dump of sugar...the reason they do this maybe is cuz they are
assuming most diabetics are on NPH or Lente which has such erratic
peaks...there is no point in maintiang your bf at 140-200 for the previous 24
hours if you have to come out of hte surgery at 450 becasue they were
"scared" you might bottom out.
> Am I making a mountain out of a molehill?
no - you are the mountain...make the moles come to you for training (then
send them a bill for the in-service)
I want to be prepared so any advice would be great!
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