General anaesthetic and devices

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PhoebeC

PhoebeC

Well-Known Member
Relationship to Diabetes
Type 1
Hi all,

I use the libre 2 and omnipod (patch pump)

I am having general anaesthetic for my Sterlisation via Laparoscopy (keyhole surgery). I have asked 4 different times what I should do with my devices and my medication and each time the advice varies, I wondered if anyone else has had surgery and GA with your devices on and what you did?
It is day treatment so in and out same day, if I can eat and I am well, taking my own food.

Appointment is midday. I can't eat after 7.30am, which is fine, I will eat as normal and have my insulin but I won't take any corrective amounts and might have a little less based on my levels and I
Based on the different answers I have had decided that I will keep my devices on (my DSN said they wouldn't let me) I have been told this is okay, but they might need to take them off, I will take spares anyway. And then run my insulin a bit less so I don't have hypo and need anything to eat or drink.

I do not want to be on sliding scale, they never get it right, and I don't want to be blood testing if I am unwell or not 100%, also its easier for my family to support me when I am home this way too.

If anyone has any advice please let me know.

This is the other advice I have been given, by nurses:

Turn off the pump 12 hours before
Activate sleep mode (I clarified, they mean the amounts of insulin I have overnight)
Back to MDI the day before (MDI didn't work for me, as my team know)
My DSN said they wouldn't let me have the devices on in case I need to be defibrillated, as the devices would burn my skin? Not sure on that one.

Other than the nerves about having my diabetes in control for the operation I am so very excited to get off contraception and have normal hormones only, and no more babies 🙂
 
When I had similar laparoscopic surgery under GA, I kept all my devices attached.
I ensured both were put of the way for the surgery.
I kept my basal at my usual level and never turned off my pump.

This was all agreed with the anaesthetist who I did not meet until the morning of my surgery. So, Like you, I had some anxiety about this up to the last minute.
The anaesthetist was "in charge of keeping me alive" during the surgery which meant, as well as everything else, he was separately monitoring my BG and was able to add glucose or additional insulin to the drip if he felt it was necessary as this would not affect the pump.
As it happened, it was not necessary for him to make any adjustments to my diabetes management during surgery and I was in charge as soon as I came back round.

So, it is definitely possible to stay attached but it is down to one person to decide - the anaesthetist. Not your DSN (they will not be there) or the surgeon (he will be busy with other things).

As for defibrillation, that was never discussed.
 
I didn’t need a C section under GA but the anaesthetist came in and discussed it with me (long labour). I said I wanted to keep my pump on and she said that was ok. She said that if there was an emergency she might need to remove it but that that was very unlikely.

Previously I’d had a short GA for an emergency op (probably a 30 min thing) and kept my pump on.

I think it depends how long the operation will take.
 
I think @SB2015 had a GA with her pump...I might be mistaken tho.
 
When I had emergency surgery for a blocked colon I went in with Libre fitted and working it was on and available throughout. That all worked well.

This was the occasion when I reluctantly and stupidly agreed to be managed on a sliding scale during the operation period. I came round from the anaesthetic Post op to hear my low alarm, checked decided I needed a JB or 2. Called for and asked the nurse who read the sliding scale protocol and determined because I was low the protocol said I needed more insulin! A one-sided argument ensued with me refusing to allow that and insisted I was removed from the sliding scale immediately. Then took JBs and fell asleep.

The main lesson here is, if the anaesthetist insists, to read thoroughly and check such an obvious mistake has not been incorporated into the sliding scale written protocol. The Nurse was doing what was written, which after all is why there are written protocols.
 
Had surgery on knee 5 years ago @PhoebeC under GA , kept pump & libre on & surgeon & anaesthetist was find with this, just kept normal basal rate running during surgery but increased it afterwards as bg started to rise due to stress of it all.
 
When I had my mastectomy in 2022, I kept my Tandem on all the time and was scheduled to be first. I only met the anaesthetist that morning and I showed her how to view my bs on the pump, but not anything else, (just in case she wanted to interfere!). She was more than happy that I was in control of my blood sugar levels and left it to me to sort myself out when I came round a couple of hours later (when I was higher than I liked so immediately added a bolus)
Hope it goes well for you.
 
One extra memory I just had wrt my LaSH - whilst it is day surgery for most people, because I have diabetes, I was kept in overnight to make sure my BG was not adversely affected. The nurse woke me every hour to check my BG. I say "every hour" but, at about 3am, she decided I was doing so well that there was no need to disturb me again. Unfortunately, she neglected to tell me so when I woke at 3am, I stayed awake reading and waiting for her to arrive as there was no point going back to sleep.
Thankfully, it was decided I could go home the next day .. at 6am hours before my lift home was awake.

But these are small gripes in an otherwise straightforward surgery. I gave up on the painkillers within a couple of days because I could feel no pain and spent the second half of my 2 week sick leave going on walks which isn't bad considering I was told recovery could take 2 months. I am sure my fitness helped and your rugby playing will be to your advantage (as long as you take a bit of a break).

Good luck @PhoebeC
 
helli said:
One extra memory I just had wrt my LaSH - whilst it is day surgery for most people, because I have diabetes, I was kept in overnight to make sure my BG was not adversely affected. The nurse woke me every hour to check my BG. I say "every hour" but, at about 3am, she decided I was doing so well that there was no need to disturb me again. Unfortunately, she neglected to tell me so when I woke at 3am, I stayed awake reading and waiting for her to arrive as there was no point going back to sleep.
Thankfully, it was decided I could go home the next day .. at 6am hours before my lift home was awake.

But these are small gripes in an otherwise straightforward surgery. I gave up on the painkillers within a couple of days because I could feel no pain and spent the second half of my 2 week sick leave going on walks which isn't bad considering I was told recovery could take 2 months. I am sure my fitness helped and your rugby playing will be to your advantage (as long as you take a bit of a break).

Good luck @PhoebeC
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I have only told work I need a week, I work from home and no doubt will be bored out of my mind by day 2 of doing nothing. I can take more time if needed and they know this so no pressure.

Urgh the waking every hour I remember from when I was pregnant. We wouldn’t do it if ill at home.
 
Bloden said:
I think @SB2015 had a GA with her pump...I might be mistaken tho.
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Hi @PhoebeC i have had a couple of GAs since being on my pump.

For one it was spinal surgery and they would be using X-ray during the op so that required me to be on sliding scale. I was very worried about it, but along with the DSN we came up with a plan about returning to my pump as soon as I was able. I was very dozy and vomiting after the op and very glad not to have to think about anything else. The sliding scale was managed well and I was given clear explanations of any changes they made. My DSN also popped up to see that all was okay

Another I was left to use my pump and we agreed what the anaesthetist would do regarding any alarms, and I showed him how to see my levels at any time. He asked me what I wanted my level to be when I woke up. All went well and was exactly on target.

My advice is talk to them and agree what is going to happen. I hope all goes well.
 
Fingers crossed it all goes well @PhoebeC 🙂

Best wishes for a speedy recovery.
 
Just keeping you all updated.

No after 7.30am so I woke up at 6am so I could get enough food and tea into me, it was pump change day anyway.
Here at 12pm, taken down about 3pm. Woke up about 5.30pm.

I have had a wee, walked about, had some food.

Surgery a success. Just waiting for discharge now with Mr C on the way.

And look at tvisIMG_4127.png
 
Thanks all for the advice and support.
When I met the surgeon beforehand I asked if I could stay on my own pump and not have the sliding scale.
She said talk to the anaesthetist but she couldn’t see why not and it makes more sense for me to be in control if I felt able.

Blood sugars are stable averaging at 10, 61% in range.
They let me keep on my devices and used these to monitor when I was under, no alarms as I stayed in range. As soon as I was awake again I managed my diabetes myself. I felt better about this. Giving myself a gold star.

Only issue is eating, I feel very nauseous and it taking me so long to eat. Oh and the pain ha!

Again thank you. Going in I knew I could request I kept control and I was prepared to explain why, and show them how to work the devices. I said “I’ve done my research”
 
Glad you were able to keep your devices on during the surgery. That must have been a relief.
I think GA can cause nausea and possibly some of the pain killers you are given. But hopefully it wears off soon.
Regarding the pain, my consultant told me "You have been stabbed three times. What do you expect?" Probably not the most helpful but again I hope it doesn't last too long. However, don't rush to get better. Take your time, take care and rest.
 
helli said:
Glad you were able to keep your devices on during the surgery. That must have been a relief.
I think GA can cause nausea and possibly some of the pain killers you are given. But hopefully it wears off soon.
Regarding the pain, my consultant told me "You have been stabbed three times. What do you expect?" Probably not the most helpful but again I hope it doesn't last too long. However, don't rush to get better. Take your time, take care and rest.
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This is exactly what my husband said :D

He also keeps saying “minor” but minor is still surgery, and which one of us got it done.

So happy it is done at last.

And not only was every member of team at the hospital great and professional, they were beyond supportive, caring and helpful. I felt their love in all of it. We are blessed with the NHS.
 
So pleased it went smoothly for you and you retained your pump and diabetes management and well done to you and the pump for the impressive graph.
Hope your recovery is smooth and without glitch too and the pain subsides soon. .
 
Thanks for the update Phoebe. So pleased that they let you stay on your pump and that it behaved well.
Rest well and recover soon.
 
helli said:
The nurse woke me every hour to check my BG. I say "every hour" but, at about 3am, she decided I was doing so well that there was no need to disturb me again. Unfortunately, she neglected to tell me so when I woke at 3am, I stayed awake reading and waiting for her to arrive as there was no point going back to sleep.
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I was pleased on one hospital stay that they were willing to use my sensor reading overnight (early days of Libre with a reader. They swiped me each hour and I slept.

On one night the nurse swiped to check glucose levels each hour but then woke me to check my wrist band each time !!!!
 
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