Well,
@SB2015, my GOOD tale about VRII is that while I was having my pancreatectomy I was placed onto VRII and stayed on that for about 10 days, before being moved to MDI. It can work; well. Of course I was in a diabetic environment, within the HPB ward and being closely monitored by people who knew what should be happening. I was at that stage totally oblivious of all of this, rather more bemused by counting the various tubes radiating out of me: drips in drains out! Over 15 of them.
I think you've made a good call by asking for sight of the Hospital's protocols. I suggest no need to be scared while you are in Theatre - there will be an anaesthetist monitoring your every breath! You should get to meet that anaesthetist on your ward, before you go to Theatre and it would be worth having a conversation with him/her about the transition period post op. In the Bucks Hospital where this stupid event occurred with me, I was struck both before and after my surgery about how poor the Endocrinology advice was to the Ward or Theatre and absolutely no direct involvement they had with me.
The pre-op process was in part excellent, then really poor when we got to their requirements for my insulin preparation the night before. The excellent and senior nurse doing this had a written instruction, provided by the Hospital's Endo dep't which listed all basal in one category and telling me to stop my Tresiba on the day. I politely told the Nurse that I wouldn't do that; if the requirement was really for me to have zero insulin on board on the op day, then I should start that a couple of days before; but that made no sense and in practice it was my bolus that needed curtailing NOT my basal. This Nurse clearly understood my rationale and agreed to advise the Endo Dep't that their protocol seemed suspect. I e-mailed her after we met, confirming my perspective and formally asking her to confirm we were now in common agreement. She replied, telling me my email had been forwarded to Endo. I heard nothing more.
On the day, I showed up and was asked to confirm by signing a statement that I'd stopped my basal. I explained that I hadn't and why, the young inexperienced reception Nurse went to get advice, returned to tell me my op couldn't continue. I had copies of my email exchanges to hand, persuaded her supervisor to speak with the pre-op nurse and this detail got sorted. No stress to start my op!! Later the anaesthetist confirmed I was correct to keep my basal going, he would not deliberately want to be managing my BG with the stress from surgery etc and me with zero basal on board! That Hospital's Endo Dep't is well adrift from understanding how to manage someone like me with no panc'y.
What I didn't ask the anaesthetist was to see the post-op VRII protocol. I did tell him I'd prefer to not go onto VRII, but allowed him to convince me that it was preferable; I naively assumed it was a fully automated process, not dependent on a VRII alarm and someone manually adjusting the proportion of insulin and glucose after reading protocol instructions. I spent over 3 weeks on that ward, without speaking to anyone from Endo - yet (theoretically) every insulin medication decision was being aporoved by the Endo Dep't. In practice I had my pens and managed myself; with such a long period relatively immobile (some shuffling walks around the ward and no walking to the shops or gardening!) my TIR was the best it's ever been. Retaining my pens was initially a challenge (I sort of understand this) but I simply didn't allow the conversation to progress to a point that they made me put my pens in a locked cubpboard/locker that I didn't have the key for. We "danced" around this problem for several days until eventually I'd established a status quo; one Dispensing Nurse was very "tense" (= resentful) about my being outside her protocols.
Overall, forewarned is forearmed and pre-op conversations will go a long way to make sure you are treated as an individual and your concerns, fears, are properly managed. Good luck,
@SB2015, I look forward to hearing after your op how it all went.
