My type 2 husband has been using insulin for 6 weeks, so it's quite new and he has the occasional low and high(ish). About 70% in range and using libre2. Before insulin he was in range zero times. He has a biopsy this Tuesday at 12.30, nothing to eat after 8am. He can have his morning insulin, 10 mins before breakfast, then nil by mouth. Usually, he has his next insulin at 13:00. This won't be possible. Firstly I'm concerned about is if he has a low sugar problem between 8:00 and 12:30. Should he take a lower dose of insulin before breakfast? Or no insulin? The hospital phoned late Friday afternoon with a cancellation, he didn't ask the right questions, and it's very hard to get hold of the diabetes specialist nurse. I hope this makes sense.
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New to insulin and have operation this Tuesday!
- Thread starter Sue31
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Can you tell us what 8nsulin your husband is taking?.There Are a number of different types and the way they work effects how and when you take them
I have been taking insulin for 20byears and during that time, 8 have had a couple of surgeries where I need to fast and have been able to manage.
In my experience lows have not been an issue because the stress of the operation has caused my levels to rise.
I have been taking insulin for 20byears and during that time, 8 have had a couple of surgeries where I need to fast and have been able to manage.
In my experience lows have not been an issue because the stress of the operation has caused my levels to rise.
Thank you so much for replying H.
He is taking Novorapid in the day. 3 times a day, 10 minutes before breakfast, lunch and dinner. The amount being injected is variable at the moment as he's pretty much been left to it. One telephone call with diabetes nurse since original face to face consultation on 5th June. This was the first day he took insulin, and this would not have happened but for a visit of desperation to A&E. He's currently taking 8 6 and 8Novorapid due to very low sugar after lunch.
Just before bed, he takes Toujeo, 24 units.
That's interesting about the operation causing levels to rise.
Ideally, the biopsy would be at 8am, I think.
Any advice gratefully received.
He is taking Novorapid in the day. 3 times a day, 10 minutes before breakfast, lunch and dinner. The amount being injected is variable at the moment as he's pretty much been left to it. One telephone call with diabetes nurse since original face to face consultation on 5th June. This was the first day he took insulin, and this would not have happened but for a visit of desperation to A&E. He's currently taking 8 6 and 8Novorapid due to very low sugar after lunch.
Just before bed, he takes Toujeo, 24 units.
That's interesting about the operation causing levels to rise.
Ideally, the biopsy would be at 8am, I think.
Any advice gratefully received.
Inka
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If he’s only taking Novorapid, I’d skip his morning dose that day and either eat no breakfast or, if he can’t manage that, eat a breakfast with minimal carbs eg a couple of boiled eggs or similar. From what you’ve said, I’m unclear if he actually has to fast before the biopsy or not.
Hi Inka, As I said, he didn't ask the right questions or more accurately, he didn't ask any questions! Arrgghh! They know he's diabetic but as the change to insulin was very recent, they might not know that. I have no idea if he's having a GA and he doesn't know how long the biopsy will take. I will be calling the department on Monday and ask all the questions you posed. Thank you so much.
He told me the person on the phone said nil by mouth from 8:00 and the biopsy is due for 12:30. I will call the hospital on Monday. I make the phone calls as he is quite deaf so the information he's given me might well be incorrect. Thank you for your help. I will leave a message for his diabetes nurse but I have done that regarding a future appointment and did not get a reply plus the diabetes contact email address on the NHS letter bounces.
Only novorapid in the day. I am also unclear if he has to fast as 4 hours 30 mins from 8:00 until 12:30 doesn't seem long enough for a GA.
Isn't it! I feel much better after talking to you and H. Thank both of you so much.
Inka
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Perhaps they said 8pm? Fasting is usually from the night before. Or maybe they just want him not to have eaten for 4hrs previously? It’s quite confusing. You could try googling the particular biopsy he is having to see if that gives you a clue. If you’re not able to find out, I’d have him fast from the night before just to be safe, not take his morning Novorapid and not eat any breakfast at all.
@Sue31 NovoRapid is taken with food. It is not taken at certain times of the day. If your husband eats earlier, he takes his insulin earlier. If he eats later, he doses later. If he misses a meal, he doesn't take insulin for that meal.
So, if his next dose is not due at 1pm. It is due when he next eats.
You mentioned he is on fixed doses. This means he needs to be careful to eat approximately the same amount of carbs for each meal as it is the carbs that the body converts to glucose that need the insulin.
So, if he eats a low carb / no carb breakfast like a couple of boiled eggs (without toast), as @Inka suggested, he should not take his insulin with that breakfast.
So, if his next dose is not due at 1pm. It is due when he next eats.
You mentioned he is on fixed doses. This means he needs to be careful to eat approximately the same amount of carbs for each meal as it is the carbs that the body converts to glucose that need the insulin.
So, if he eats a low carb / no carb breakfast like a couple of boiled eggs (without toast), as @Inka suggested, he should not take his insulin with that breakfast.
Quite likely! Great idea to search for the procedure. I did not think of that.
Yes, it all makes sense when you say it! Diabetes nurse said novorapid 10 minutes before eating. Yes I understand it's for meal times. I'm just not very good at explaining. Thank you for the carbs tip. My husband has been type 2 for 13 years and has never been overweight. He has steadily been losing weight since taking gliclazide and metformin due to his regular vomiting after the evening meal. He's practically bulimic. On 5th June he weighed just over 9 stone and he's about 5 foot 9. Yesterday he was a stone heavier and he needs to put on weight bc he's so very thin. I will call the hospital on Monday for more information. Thank you all and have a lovely day.
rebrascora
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This is a big red flag for him possibly being Type 1 or maybe Type 3c. Is the biopsy anything to do with his pancreas?
Him vomiting after his evening meal is most concerning but the important thing is that he is now on a suitable insulin regime and has Libre to monitor his levels.
I am not going to comment further on his prep for the op because until you have more info, we are all just guessing. Hopefully you will be able to get more clarity on Monday and then come back to us, but wishing him well with the procedure. Usually they do a preop assessment which includes and HbA1c. If his levels have been very high recently prior to starting the insulin, that might mean they won't do the op until they come down. HbA1c is a kind of 3monthly average of BG levels and for most surgery there is a cut off point above which they will not operate for risk of infection, because the body is more prone to infection when BG levels are high. It may be that this doesn't apply for a biopsy but I would be very surprised if that is the case. The anaesthetist will also have a vested interest in him now being insulin dependent if it is a GA, so this all needs to be ironed out in advance.
Wishing your husband well and hope he is able to get the biopsy on Tuesday, but it is important to be thorough in understanding what is involved and what he needs to do to prepare for it, so do be prepared to badger the appropriate people for correct information. I imagine it is a very worrying time for you both and getting this biopsy sooner rather than later will be important, but equally important to make sure everyone is on the same page with what is required and I would ask about the HbA1c cut of for having the op, because he could get fast, get there all psyched up and then find his result is too high to go ahead.
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Hope the biopsy goes well tomorrow @Sue31
As long as his Toujeo dose is right for him (at the moment, doses can change through the year) he should be free to skip or delay any meals he needs to to fit around the procedure, as others have explained.
His Toujeo is acting as a background insulin, which is dealing with glucose trickled out by the liver 24 hours a day. It should hold his levels steady whenever he is not eating (carbs) and has no active rapid insulin.
This should mean he can stay within 1-2mmol/L up or down until his next meal - whenever that is.
Of course, if hip levels dip into hypo territory (eg if hos Toujeo ‘background’ dose is slightly too high at the moment) then he will need to eat to treat the low BG and just let the biopsy people know what happened. They can then decide whether the procedure can go ahead or needs to be delayed slightly.
Fingers crossed it all goes ahead smoothly 🙂
As long as his Toujeo dose is right for him (at the moment, doses can change through the year) he should be free to skip or delay any meals he needs to to fit around the procedure, as others have explained.
His Toujeo is acting as a background insulin, which is dealing with glucose trickled out by the liver 24 hours a day. It should hold his levels steady whenever he is not eating (carbs) and has no active rapid insulin.
This should mean he can stay within 1-2mmol/L up or down until his next meal - whenever that is.
Of course, if hip levels dip into hypo territory (eg if hos Toujeo ‘background’ dose is slightly too high at the moment) then he will need to eat to treat the low BG and just let the biopsy people know what happened. They can then decide whether the procedure can go ahead or needs to be delayed slightly.
Fingers crossed it all goes ahead smoothly 🙂
SB2015
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