My Auntie - Type 2

[newbs]

My Auntie has had Type 2 diabetes for several years and been on tablets but her most recent HbA1c was in the 20's so she has to go on insulin. She was due to have her knee replaced 2 weeks ago but the anaesthetist refused due to the possibility of her not coming around from the operation and also the obvious problems with healing afterwards etc. She had a call yesterday to say that she is being admitted to a different hospital on monday, will be on insulin for 3 days then having the knee replacement on thursday! 😱

I am concerned that this hospital is happy to go ahead so soon after the other refused for very good reasons. Surely 3 days on insulin isn't enough to say her diabetes is stable enough to avoid the associated problems? How would you all feel?

I am very concerned about her, my auntie and I are very close.

 

[Northerner]

It does surprise me, given that her control has obviously been so poor for the previous few weeks as indicated by her HbA1c. Whilst it is true that they can have very close control over her levels in the hospital, I would have thought that the timescale is very short. I have obviously no idea, though, since I have no experience or knowledge other than the fact that my levels were still quite up and down during 8 days in hospital. Have they given you any risk levels and how do these compare with the first anaesthetist? Is it essential that she has the operation now or can she wait for her levels to improve and stabilise?

 

[FM001]

How awful for your aunt to be running such high levels for so long to achieve a a1c in the 20's, lets hope after the operation they can keep her levels nearer to normal levels. The insulin will almost immediately begin to stabilise her blood glucose levels, but like you do have concerns that 3 days does seem a very short time after to face the prospects of a operation. No doubt the surgeon and anesthetist will have carried out a risk assessment prior to this, but I suggest that you express your concerns to the staff involved and ask your aunt if she is happy to go ahead with the OP. Hope all goes well next week! Toby.

 

[Copepod]

Although Newbs' aunt's HbA1c is very high, it's not unusual for people on tablets to treat type 2 diabetes to be brought into hopistal ahead of planned surgery to be put on insulin, on a sliding scale for insulin and glucose drips / pumps, as they need to be nil by mouth for general anaesthetic. Personally, I have a lot of trust in doctors, and anaesthetists particularly.
There's a different issue of what treatment Newbs' aunt has after the surgery eg continue on insulin / use Byetta (or similar) / return to tablets alone.

 

[Northerner]

Although Newbs' aunt's HbA1c is very high, it's not unusual for people on tablets to treat type 2 diabetes to be brought into hopistal ahead of planned surgery to be put on insulin, on a sliding scale for insulin and glucose drips / pumps, as they need to be nil by mouth for general anaesthetic. Personally, I have a lot of trust in doctors, and anaesthetists particularly. ...

I think the problem is the conflict in the different hospital/anaesthetists' opinion of the outcome - which opinion do you trust most and how can you determine that?

 

[Copepod]

It could well be that there are different facilities at the two hospitals eg not willing to undertake surgery where there is no ITU / no overnight consultant anaesthetist cover etc. So, different answers from different hopsitals could be entirely appropriate.

 

[Northerner]

It could well be that there are different facilities at the two hospitals eg not willing to undertake surgery where there is no ITU / no overnight consultant anaesthetist cover etc. So, different answers from different hopsitals could be entirely appropriate.

That could be a very reasonable explanation, but not necessarily one that has been successfully communicated to newbs and/or her Auntie, so hopefully this will be something that can be requested if that's the case.

 

[Copepod]

I'm not sure that Newby actually attended appointments with her auntie, but it's not normal for NHS to inform relatives who don't attend / are not next kin (which she might be, of course) of admission dates etc - it would be a big expense to collect contact details, then phone / write / text / email (according to preferences). So, while communication is very important, there are occasionally unreasonable expectations, but I'm not assuming what Newby expected, just presenting a bit of understanding of how NHS works.

 

[newbs]

It could well be that there are different facilities at the two hospitals eg not willing to undertake surgery where there is no ITU / no overnight consultant anaesthetist cover etc. So, different answers from different hopsitals could be entirely appropriate.

Thanks everyone for your replies, in particular yours Copepod as it makes a lot of sense. The original hospital is a lot smaller than the one that she will now be having the op at and they don't have an ITU etc whereas this one does - they are things that I wouldn't have thought about and do make me feel a bit better. The op is necessary as my auntie is currently in a wheelchair.

Thanks again.

 

[Caroline]

Having the knee done will give a better quality of life, so I hope the op is a success.

What works at one hospital doesn't always work at another, which is why we often hear of people being transferred to different hospitals.

I find if I don't ask questions no one will tell me, and any good medical team should be happy to answer, explain and reassure. A patient that is not worried is easier to treat than one that is, so I would suggest everyone asks questions.

 

[Copepod]

Hi Newbs
Really glad my explanations helped you. Best wishes for your Auntie's operation and recovery - and for your part in supporting her. Having worked for the NHS, I appreciate that staff don't always explain things as well as possible, but also have to work within confines of patient confidentiality etc.