General anaesthetic, really need som eadvice and support

[Type1Adventurer]

Okay so, long story short. Type 1 for almost 29 years, activey support others with type 1 but find myself lost and not knowing what to do or expect.
I have to go for surgery to remove a lump on my jaw bone and i don't yet know how many teeth or how much bone they will need to take. Could be sinister, but won't know till they get the growth out and do tests.
Due to a sever low and almost dying in 2022 i have PTSD-DS, major issues for me are not feeling in control of my body, not being in control of my sugars, that feeling of being in between asleep and awake.
I am in therapy for the above, but mention them becasue they impact what i'm facing.
So, never had a genral before, not sure what to expect or how it will impact my type 1. Currently on dex g6 and op5.
Can anyone please let me know:
- what going under and coming back awake is like with type 1, adverse effects, how it was in general, how soon could you take back control of your numbers?
-how were your numbers on the day?
-How did the hospital look after your type 1? - any issues?

Thank you all for your time and any advice / tips

Jo

 

[John Gray]

Welcome Jo!

I can only speak as a Type 2, and I absolutely love general anaesthetics! They are brilliant!
You are chatting away to the nurses and doctors, you have the injection, then suddenly, zonk, you aren't there any more!
The operation happens, and you are gradually brought round, feeling somewhat woozy and disorientated, which state takes about half an hour to pass.

My only problem was after the operation, when I had a few days of recovery in the hospital bed. They insisted on putting me on ghastly mixed insulin, which they could never get right, and my blood sugar values varied wildly. I would have wanted to continue with my usual basal/bolus injections, which I could have done myself. (In passing, I found that morphine had almost no effect on me, but quite frequently I find that I am an "edge case".)

This happened in 2008, so I would hope diabetes care during operations has improved since then, so I wish you good fortune. As with many of these "life events", the anticipation may well be worse than the actuality...

 

[helli]

HI @Type1Adventurer
I have had GA a couple of times since my Type 1 diagnosis and had zero issues.

- what going under and coming back awake is like with type 1, adverse effects, how it was in general, how soon could you take back control of your numbers?

I was nervous beforehand so my BG was a little higher than usual but that was not an issue. I was "in control" until I was taken down for the surgery and back "in control" as soon as I alert enough to check my own BG which was within an hour of the surgery completion.

-how were your numbers on the day?

My BG was a little elevated beforehand because I was nervous. I could have raised my basal but I chose to keep it slightly higher to avoid a hypo.

-How did the hospital look after your type 1? - any issues?

The hospital did not look after my diabetes, I did. The only thing they insisted on doing was to wake me every hour to take my BG through the night. Once they were happy that is was ok (whatever their definition of "Ok" was), they stopped taking it.
This was before CGMs were common. I am not sure whether they would now be happy to take the CGM reading a leave you to sleep.

I made sure to discuss their plans for my diabetes management beforehand.
The surgeon was initially talking about putting me on the "sliding scale" but said it was ultimately up to the anaesthetist. The anaesthetist was happy to monitor my BG during surgeon and leave me to manage it as normal before and afterwards. I never used the sliding scale and was always able to calculate and inject my own insulin dose. My insulin was never taken away from me.
I have a pump which remained attached. The anaesthetist required a little bit of instruction on how it worked. We agreed that he would not touch it but, if needed would administer addition insulin and/or glucose separately. It was not needed.

 

[everydayupsanddowns]

I made sure to discuss their plans for my diabetes management beforehand.

I think that’s really important, and is certainly something you’ll want to do @Type1Adventurer

The surgeon was initially talking about putting me on the "sliding scale" but said it was ultimately up to the anaesthetist. The anaesthetist was happy to monitor my BG during surgeon and leave me to manage it as normal before and afterwards. I never used the sliding scale and was always able to calculate and inject my own insulin dose. My insulin was never taken away from me.

Sliding scales are an earlier form of pump therapy, before pumps were much of a thing from what I can make out. These days, as long as the clinicians are happy, I think the advice is to remain on the person’s own pump

I have a pump which remained attached. The anaesthetist required a little bit of instruction on how it worked. We agreed that he would not touch it but, if needed would administer addition insulin and/or glucose separately. It was not needed.

Hope the op goes well, and that you are able to keep your anxiety and worry under control @Type1Adventurer

Hope everything comes out as benign, and there’s not much material that needs to be removed from your jaw too.

Let us know how you get on.

 

[Flower]

Hello & welcome @Type1Adventurer

I’ve had a number of general anaesthetics over the years, the last one was the first with my pump/cgm still working all previous were sliding scales. Hopefully as a T1 you will usually be first on the operating list unless there are others who need priority. This helps reduce waiting anxiety & managing blood sugars without eating/drinking.

The anaesthetist told me what would happen & if I needed a glucose drip then they’d put on up. I checked my glucose just before going to surgery They were reassuring and have seen & dealt with it before, increasingly so with pumps/HCL. I felt well looked after by the anaesthetist and not out of control,

The staff afterwards in recovery checked my glucose by finger prick and compared it to my cgm. I was pretty sick for a few hours after surgery which isn’t great with insulin but managed not to go hypo. After a stressful experience my blood sugar did go a bit haywire but with gentle corrections it settled down.

Keep your diabetes kit, insulin & hypo treatments within easy reach once you’re back on the ward & as soon as you feel with it/well enough take control & do what you know works for you.

I hope the operation goes well for you and you are able to feel reassured about things. Best wishes

 

[Type1Adventurer]

Welcome Jo!

I can only speak as a Type 2, and I absolutely love general anaesthetics! They are brilliant!
You are chatting away to the nurses and doctors, you have the injection, then suddenly, zonk, you aren't there any more!
The operation happens, and you are gradually brought round, feeling somewhat woozy and disorientated, which state takes about half an hour to pass.

My only problem was after the operation, when I had a few days of recovery in the hospital bed. They insisted on putting me on ghastly mixed insulin, which they could never get right, and my blood sugar values varied wildly. I would have wanted to continue with my usual basal/bolus injections, which I could have done myself. (In passing, I found that morphine had almost no effect on me, but quite frequently I find that I am an "edge case".)

This happened in 2008, so I would hope diabetes care during operations has improved since then, so I wish you good fortune. As with many of these "life events", the anticipation may well be worse than the actuality...

Initially is was against general and was asking for local, but having learned more about what they need to do, i think being under general is the better option haha!
I'm expecting to run a little higher thank i would like due to stress etc, i think it's more not being in control of it that's getting me worked up. The more positive stories i'm hearing though, the better i'm feeling about it.
Thank you!

 

[Type1Adventurer]

HI @Type1Adventurer
I have had GA a couple of times since my Type 1 diagnosis and had zero issues.

I was nervous beforehand so my BG was a little higher than usual but that was not an issue. I was "in control" until I was taken down for the surgery and back "in control" as soon as I alert enough to check my own BG which was within an hour of the surgery completion.

My BG was a little elevated beforehand because I was nervous. I could have raised my basal but I chose to keep it slightly higher to avoid a hypo.

The hospital did not look after my diabetes, I did. The only thing they insisted on doing was to wake me every hour to take my BG through the night. Once they were happy that is was ok (whatever their definition of "Ok" was), they stopped taking it.
This was before CGMs were common. I am not sure whether they would now be happy to take the CGM reading a leave you to sleep.

I made sure to discuss their plans for my diabetes management beforehand.
The surgeon was initially talking about putting me on the "sliding scale" but said it was ultimately up to the anaesthetist. The anaesthetist was happy to monitor my BG during surgeon and leave me to manage it as normal before and afterwards. I never used the sliding scale and was always able to calculate and inject my own insulin dose. My insulin was never taken away from me.
I have a pump which remained attached. The anaesthetist required a little bit of instruction on how it worked. We agreed that he would not touch it but, if needed would administer addition insulin and/or glucose separately. It was not needed.

That really helps calm things for me, thank you! It should all be wrapped up within a couple of hours for me and then it's just recovery etc, so i'm hoping i'll only be not in control for a few hours. Just waiting on appointments to speak to the team that'll be doing it at the mo.

 

[Type1Adventurer]

I think that’s really important, and is certainly something you’ll want to do @Type1Adventurer

Sliding scales are an earlier form of pump therapy, before pumps were much of a thing from what I can make out. These days, as long as the clinicians are happy, I think the advice is to remain on the person’s own pump


Hope the op goes well, and that you are able to keep your anxiety and worry under control @Type1Adventurer

Hope everything comes out as benign, and there’s not much material that needs to be removed from your jaw too.

Let us know how you get on.

Thank you! Fingers crossed!

 

[Type1Adventurer]

Hello & welcome @Type1Adventurer

I’ve had a number of general anaesthetics over the years, the last one was the first with my pump/cgm still working all previous were sliding scales. Hopefully as a T1 you will usually be first on the operating list unless there are others who need priority. This helps reduce waiting anxiety & managing blood sugars without eating/drinking.

The anaesthetist told me what would happen & if I needed a glucose drip then they’d put on up. I checked my glucose just before going to surgery They were reassuring and have seen & dealt with it before, increasingly so with pumps/HCL. I felt well looked after by the anaesthetist and not out of control,

The staff afterwards in recovery checked my glucose by finger prick and compared it to my cgm. I was pretty sick for a few hours after surgery which isn’t great with insulin but managed not to go hypo. After a stressful experience my blood sugar did go a bit haywire but with gentle corrections it settled down.

Keep your diabetes kit, insulin & hypo treatments within easy reach once you’re back on the ward & as soon as you feel with it/well enough take control & do what you know works for you.

I hope the operation goes well for you and you are able to feel reassured about things. Best wishes

Thank you. i'm hoping i can be first in and get it out of the way fairly early. Hoping to be a day case too then i can get home and curl up in my duvet like a sausage roll haha! I think once i've been able to speak to the team doing it i'll be more at ease, can't beat guidance and experiences from other diabetics though. I'm sure in a few short weeks i'll be sharing my positive experrience with somone else facing the same worries i'm facing now!

 

[Bruce Stephens]

That really helps calm things for me, thank you! It should all be wrapped up within a couple of hours for me and then it's just recovery etc, so i'm hoping i'll only be not in control for a few hours. Just waiting on appointments to speak to the team that'll be doing it at the mo.

Yes, I wouldn't worry. We're unusual but we're not that unusual. There are procedures in place to keep us safe, an important part of which is to talk things over with the patient (the expert in this case). Should you need to be in hospital for more than a day, as I understand it it's been agreed that you should be responsible for your diabetes during your stay (because again, you're the expert). (Which was all the case on the one case I've had GA, a decade or so ago.)

 

[Type1Adventurer]

Yes, I wouldn't worry. We're unusual but we're not that unusual. There are procedures in place to keep us safe, an important part of which is to talk things over with the patient (the expert in this case). Should you need to be in hospital for more than a day, as I understand it it's been agreed that you should be responsible for your diabetes during your stay (because again, you're the expert). (Which was all the case on the one case I've had GA, a decade or so ago.)

Thank you!

 

[rebrascora]

It should all be wrapped up within a couple of hours for me and then it's just recovery etc, so i'm hoping i'll only be not in control for a few hours.

Would it help to see this the same as when you go to asleep every night, except that in this situation you have someone there (the anaesthetist) to look after you and deal with anything that needs dealing with whilst you sleep. Nothing desperately bad can happen diabetes wise in a couple of hours, especially with no meal bolus in your system and it is likely that your levels will rise and be a bit high due to anxiety rather than low, but if you do go low the anaesthetist will be monitoring very closely and give you glucose. Sort of like having a guardian angel looking after you whilst you sleep.
Must confess I haven't had a GA since my diabetes diagnosis but have had a couple before it and they were great. Once for appendectomy and once for wisdom teeth removal, so I suppose the latter was a little similar although obviously much more minor. Much as I am a control freak and seem to be getting worse as I get older in that respect, I definitely think GA for something like that is preferable and probably more so with diabetes as anxiety would push my levels through the roof, so I would expect my D to be much steadier and easier to manage if I was out for the count.

Hoping the surgery all goes very smoothly for you and a very speedy recovery and that tests all come back benign.

 

[trophywench]

What Barbara omits though is that your body is going to undergo an immense trauma and the body's normal unalterable response to trauma is to immediately a) shove some glucose into our bloodstream (similar to the Dawn Phenomenon response only that's to provide the energy to go forth and hunt, gather or slay the woolly mammoth to feed ourselves or fight the enemy or whatever) and b) start the usual 'fight or flight' response, and there is sod all anyone, be that you or a doctor, can do to prevent that - it is what the human body does!

So mate - it's nob all like normal sleep!

I've had a few GAs and can't say they've all been wonderful but hey what was wrong was sorted and here I still am - which is the main thing! And so will you be! 🙂 🙂

 

[Quizzy]

Just a caution about general anaesthtic, if you haven't had the experience before, make sure you check the Apfel score for PONV (post operative nausea and vomiting) he Apfel simplified risk score, developed in 1999, is the most widely used tool for risk stratification of postoperative nausea and vomiting (PONV). It includes four risk factors: female sex, non-smoking status, history of PONV or motion sickness, and use of postoperative opioids. They didn't. I didn't, disaster!!

 

[DaveB]

Hi. I've had several Generals (I'm a LADA). I wouldn't worry. Most of mine had been when I went Private which possibly allows you more control. Ensure that you hold onto your insulin near the bed and manage your injections etc. Allow them to know your current BS or do a finger prick whenever the nurse wants. I've never had any problems whilst 'under' or in recovery due to the diabetes or insulin. Avoid Sliding Scale like the plague as many nurses haven't a clue on managing insulin/glucose; I've never been offered it fortunately.

 

[helli]

Just a caution about general anaesthtic, if you haven't had the experience before, make sure you check the Apfel score for PONV (post operative nausea and vomiting) he Apfel simplified risk score, developed in 1999, is the most widely used tool for risk stratification of postoperative nausea and vomiting (PONV). It includes four risk factors: female sex, non-smoking status, history of PONV or motion sickness, and use of postoperative opioids. They didn't. I didn't, disaster!!

I never used the apfel scale and, thankfully, had zero reaction.
The calculation seems rather simple it is only based on 4 things, all equally weighted. My score was 39% which, if I had known beforehand would have concerned me but I didn’t even feel nauseous.
Interestingly, this article suggests 7 pre indicators. Maybe the additional 3 were more significant for me.

 

[nonethewiser]

Had 4 ops using GA both on injections & pump, was once on sliding scale when injecting & that kept my bg levels mega tight.

Last 2 have been on pump, so increase basal rate to cope with trauma prior to & afterwards.

Never felt vulnerable or afraid of GA, the risks they warn you about are small thankfully but they have to tell you nonetheless. Good luck & try not to worry.

 

[Bloden]

I had a GA in 2020 when I was still on MDI. The anaesthetist monitored my BG while I was under (she must’ve pricked my earlobes for blood, because there were lots of little prick marks on them LOL). A nurse woke me every hour through the night to do a finger prick - it had to be a finger prick, not CGM, she said. She had to get the duty consultant in to approve a correction dose - lots of internal eye-rolling from me cos there was no risk as far as I was concerned, but she was doing her job by the book. The only thing I’d do differently next time would be to keep a closer eye on ketones - because I hadn’t eaten and had also thrown up after the op my ketones were too high for a short while in the afternoon. The staff were all brilliant.

I had to laugh at the dietician’s recommendation for breakfast the next day (it was written in the care plan) - brown toast...eek! Yeah, perfect, if I want to be high all morning!

 

[trophywench]

Oh, yeah - it turned out after I had a very short GA (elective laparoscopic sterilisation 'last century') that I throw up after them. Once you know, there's a jab they can give you that usually stops it very well indeed. Until you and the medical profession know this, unfortunately the only way of finding out - is to have a GA.