@victorhamesse, I can't do anything about my missing glucagon or somostatin, except:
1. Be aware this is my reality.
2. "Think Like a Pancreas".
A Consultant, in answering why I could "enjoy" Foot on the Floor (FotF) or the Dawn Phenomenum (DP) since I don't make Glucagon, replied they weren't sure; but our brains are clever and our bodies learn what I call workarounds, so probably the brain triggers adrenaline or cortisol glands to create the release of glucose by the liver. There is still so much about our intrinsic complexity that nobody fully understands.
Regarding your forthcoming op, will this be under a General Anaesthetic (GA) or a more limited procedure? I had a very challenging experience immediately after a significant GA op.
Somewhat against my wishes, but with heavy encouragement by the Surgical Team I was put on a sliding scale with insulin or glucose being provided through a canula. The dosage was done manually and in accordance with a formula provided by the Endocrinology Department, who never spoke to me during 24 days in Hospital. I was oblivious to the existence of this formula, which had been added to my notes at some point shortly before my surgery. During the surgery I was wearing my CGM, then Libre, and the phone app was updated after the surgery when back on the Ward. The anaesthetist was specifically monitoring my breathing and my BG; all went well and my graph from that period was very steady. Shortly after my return to the ward I was drifting between awake and asleep when my Libre alarm told me I was low. I checked, verified that low and before taking a glucose response I (stupidly in hindsight) obeyed the ward instructions and I informed the Nurses before any injecting or eating. The nurse that came along looked at my medical notes and ordered me not to eat, since the sliding scale notes specifically said when in that very low range my insulin must be INCREASED. I was awake enough to say no, absolutely not; but she had the written protocol in front of her and had insufficient sense to understand the protocol was fundamentally flawed. She was about to change the dosage and I made a loud scene - demanding I was immediately taken off the sliding scale. I had some jelly babies and fell asleep. Layer , once awake a young Doctor came over and gently tried to reprimand me, but I wasn't in a mood to take that reprimand. This Dr was adamant that the protocol would be correct, because it came from the Endocrinology Depot. I poliely challenged her to look at the protocol and explain to me what bit of being low and taking more insulin could be right. She read the protocol, went silent and showed me the typed protocol amended by hand writing to correct the huge error. That amendment had been done while I was asleep in the previous couple of hours. Young Doctor disappeared with no further comment, but clearly embarrassed by what had occurred.
So the lesson I learnt was:
1. A general ward nurse doesn't have any sense of when a treatment involving insulin could be wrong. They also don't understand that we self medicate with insulin at home as a matter of routine and they can think each injection must be authorised by a Dr.
2. Ward Nurses are, of course, obliged to follow a written protocol.
3. I will never again willingly surrender my control of my BG management.
4. Should such a scenario recur, ie a GA for an unknown period, I will always insist on seeing the written instructions and check for myself what those instructions say.
5. Should such an Endocrinology error be repeated I will photograph what is written and will relentlessly pursue the Head of department and the Hospital Board to get such professional incompetence faced up to. I wish I'd taken that photo back in July '22.
Please don't let my experience wholly frighten you - your process may be absolutely fine. But do at least check that whatever is proposed for your D care makes sense. I know that following the Letby baby murders court case, Hospitals are in places overreacting and preventing patients from having their insulin close to hand. Once locked up the Patient has to go through a rarel available medications Nurse (who may refer to a wholly unavailable ward doctor) before unlocking one's own insulin. I had that potential difficulty last month during 14 hours in A & E. Fortunately a senior Staff Nurse used common sense and left my insulin with me.
Because I'd had 2 prior admissions to Hospital during '22, I was quite relaxed about my imminent op, had my BG in a good place and didn't get much BG interference during the run up to the op. One thing about time in Hospital is that you get lots of time to manage your BG from a bed or bedside armchair with little to distract you.
I also found the food menu was initially ridiculous and very difficult to carb count from. But I already knew that EVERY Hospital has a Nutrition content for every single item of food, including each meal type, updated monthly in accordance with the overarching Contract for Catering. With persistence I have, since discovering this, always persuaded, cajoled or slightly threatened a Ward Manager to find that Nutrition detail. Each time I was told, after finding the massive spreadsheet, the Ward had no idea this detail existed. In the Churchill Hospital the Nutritionist for the HPB Depot didn't know about the spreadsheet and promptly emailed her 5 colleague dieticians with the link to that detail. You can't really make these things up - Nutritionists advising Specialists on Nutition, unaware about the existence of Contract provided detailed Nutritional information. I am not naive enough to believe the spreadsheets are 100% correct; but they provide a decent guide for starting carb counting for a Hospital meal. They can also guide you before choosing your dinner at 7am about what the menu for your lunch and dinner meal actually is!. Also most wards have immediate access to Dextrose equivalent hypo response food.
