adjusting insulin for an operation

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yogababe DAFNE Graduate
St Georges Hospital, Tooting, London
4 posts

I'm scheduled for a shoulder operation which will require a full anaesthetic. I went for my pre-assessment appointment today and was really annoyed at the ignorant and nonsensical information I was given regarding adjusting my insulin for the operation. The nurse clearly had no real understanding or type 1 diabetes and wasn't listening to what I was saying. I'm on a twice daily Levemir injection and then novorapid when I eat according to the carb count of those meals. I was given a printed sheet that made no sense what so ever and the nurse just picked a random sentence off it that didn't correspond to my insulin regime (which I don't think is that unusual for a type 1 diabetic) and wrote on my form "halve usual dose of novorapid". I have no confidence in this information as it sounds utter nonsense.

Am I correct in assuming that I should continue my basal injections as normal and then when I can eat after the op, give myself my normal dose of novorapid? I anticipate my sugars will run high after the operation so will probably have to make some corrections with either my basal or fast acting insulin - or both. What would you recommend?

Warwick DAFNE Graduate
Diabetes Australia-Vic, Melbourne, Victoria
390 posts

Hey Yogababe,

If it was me, I'd be going with what I thought was best rather than some nurse who has much less understanding of how my BGs respond to stress, insulin etc.

You sound like you have a good idea of how to dose yourself beforehand. It sounds like they want you to avoid hypos during the operation, so I suggest that you dose so that it is near impossible to have a hypo during the operation, but in a way that that you won't be too high after the operation. If you are fasting before the operation, then you would only need to worry about your BI, in which case dropping it by a unit or two should avoid any hypos.

I'd also recommend giving spare insulin and spare meter to whoever is going to be your first visitor as a backup. There have been horror stories on these forums of insulin being confiscated by medical staff because they thought that they knew better than we do how to dose us. If you know you have some spare insulin available, then you won't need to worry about that happening.

It could be worth having a quick chat to your endo too as they will have lots of experience in answering this question. Perhaps you could have a quick phone call to them?

yogababe DAFNE Graduate
St Georges Hospital, Tooting, London
4 posts

Ha ha - quick phone call to my endo. There speaks someone from Australia not the UK. Best I can get is the number for the diabetes nurse at the hospital where I will be having my operation - and that was only after I kicked up a fuss and said I wanted some sensible advice from someone who has knowledge of the condition.
But basically I think I will stick to my original plan of not changing my background insulin (because the operation will definitely send my sugars high) and not taking any quick acting insulin because I won't be eating.

Good tip about the spare insulin - will hide some about my person. I also hate it when you get some hamfisted nurse testing your blood sugars - as I test myself at least four times a day I'm fairly confident I can a) do it myself and b) do it less painfully!

Thanks for the response!

SueA DAFNE Graduate
University Hospitals, Leicester
9 posts

Hi yogabebe
I had a minor operation last year that required a full anaesthetic,I was a day patient. Like you I was not filled with confidence after the pre-op assessment.
The experience on the day was much better and I was looked after well, everyone was aware of the diabetes. I did as you have suggested and took my BI as usual with no quick acting as I wasn't eating. Because I am overcautious I did a trial run of fasting a couple before to check my BI, as I was worried about having a hypo on the day and then having to eat and so not being able to have the op. On the day of the op my blood sugars were high before and after.
all the best for the op

yogababe DAFNE Graduate
St Georges Hospital, Tooting, London
4 posts

Hi SueA
Thanks for you reply. Reassuring to know that I'm not the only one confused by the nonsense pre-assessment advice they dish out. I might write to the hospital about it so they can change their stupid handouts.

I think I will stick to my plan then. especially as it worked for you. Did they allow you home the same day or did they make you stay over? Six years ago (pre DAFNE) when I had another operation, they totally panicked and made me stay in for three days until I discharged myself. I feel more confident now and unless there is a real medical need I want to be back home in my bed, not put onto a ward of incontinent, rambling old biddies as I was last time. Not at all conducive to a healthy recovery!!

Will post up how it goes in case it can benefit anyone else

HelenP DAFNE Graduate
Queensland Diabetes Centre, Brisbane, QLD
219 posts

Just a warning. I was admitted to a medical ward (blood infection) and allowed to run my own insuliin/pump. But after a couple of days of BGs being well under 10, when I had a shower and left the pump on the bed (usual practice) a nurse confiscated it. Took quite some time to get it back. The Dr thought she was doing the right thing and although the pump was written on the original admission notes the administration of the insulin was left to me and not listed on my medications. Conscientious nurse decided that as they were not administering insulin I could not have my pump!

Be aware be very aware…they are out to get you!!!!!

Additionally I have had five ops and not run into any problems with any of them. I really think you are the expert and if you are told something that you know is nonsense do what you can to challenge it. Best of luck. Helen