Sliding Scale Insulin drip???

[Rubyloo]

Hi,
Morning All, I wonder if anyone can answer a qustion for me? I had a minor op on my back last Tuesday & was advised at the pre-op ass team to reduce my night insulin by a 3rd & fast from midnight! I told them that I would wake up high in the morning & was that ok & she said those were the guidlines & to go by them. As this was the first Aneasetic I have had since being diagnosed type 1 & went with their advise! I woke up at 6am on 16.9 & by the time the consultant came around at 9am I was 21.8. They refused to do the op that morning as I also had +3 keytones. I was then put on a sliding scale (Ins & saline) until 1pm where they changed it to Ins & glucose. After I had the op I was taken off the machine & told to go back to my old regeme! Thats where the problems have stared, I have had terrible highs every day & night since, I've doubled my insulin used (Novorapid) & upped my nightime (Levemir) from 6 to 8. I have had high keytones & lost 7lb in one week. I tried to trackdown a Diabetic Nurse to no avail, the doctor called me & said just up the insulin & it should settle!
I had Hydrocortizone injections & wonder if its this thats sent everything out of control! Or is it the sliding scale that has caused all this? I became Diabetic after a major op & wonder if it could be the aneasetic made me need more Insulin! I never really had a honeymoon period & have only used small doses since diagnosis maybe now the honeymoon is over!
Sorry for the long rambling tread!
Debs

 

[Adrienne]

Hi,
Morning All, I wonder if anyone can answer a qustion for me? I had a minor op on my back last Tuesday & was advised at the pre-op ass team to reduce my night insulin by a 3rd & fast from midnight! I told them that I would wake up high in the morning & was that ok & she said those were the guidlines & to go by them. As this was the first Aneasetic I have had since being diagnosed type 1 & went with their advise! I woke up at 6am on 16.9 & by the time the consultant came around at 9am I was 21.8. They refused to do the op that morning as I also had +3 keytones. I was then put on a sliding scale (Ins & saline) until 1pm where they changed it to Ins & glucose. After I had the op I was taken off the machine & told to go back to my old regeme! Thats where the problems have stared, I have had terrible highs every day & night since, I've doubled my insulin used (Novorapid) & upped my nightime (Levemir) from 6 to 8. I have had high keytones & lost 7lb in one week. I tried to trackdown a Diabetic Nurse to no avail, the doctor called me & said just up the insulin & it should settle!
I had Hydrocortizone injections & wonder if its this thats sent everything out of control! Or is it the sliding scale that has caused all this? I became Diabetic after a major op & wonder if it could be the aneasetic made me need more Insulin! I never really had a honeymoon period & have only used small doses since diagnosis maybe now the honeymoon is over!
Sorry for the long rambling tread!
Debs

Hi Debs

Poor you, what a nightmare week for you. I hope you are ok. Maybe the high levels are like when you are ill and it takes time for your body to settle down again and this means erratic blood sugars. I think that the op is obviously a trauma and this has a knock on effect on your levels. That is my guess and it is a guess. I would wait for another week and try your best by increasing doses. You never know it could flatten back out and you will need to decrease again.

 

[Copepod]

Hope you can speak to someone in your diabetes team soon. You're right to think hydrocortisone might change your insulin requirements - it's a steroid, so can increase insulin requirements. Also, any chance of infection in your operation wound - difficult for you to assess on your back, but if it feels warm / hot, there may be some infection present. Or you may be starting a cold / flu etc... In the meantime, adjusting your insulin seems the wisest course of action.

 

[Smit]

Hi, sorry to hear about your bad experience. sadly i feel the care team have let you down. I have been diabetic 25 years and had my first ever operation in January. I was worried about my levels. I took my normal insulin the night before and woke up at 6am to have toast, as was told by the hospital to do this. All my levels went ok. As for your ketones keep an eye on them, if they continue call your doctor or go straight to A and E. Ketones can take over very quickly so keep a very close eye on them and try to drink lots of fluid to flush them out.

Hope you are on the mend soon. x x x x

 

[MCH]

I had Hydrocortizone injections & wonder if its this thats sent everything out of control!
Debs

Sorry to hear about your trouble. Is Hydrocortisone a steroid? I had a very small steroid injection in finger recently and was told it probably wouldn't affect my levels, but that if it had been a bigger injection (like for frozen shoulder) it might.

Hope things settle down soon.

 

[grovesy]

Yes it is a steroid, I had my knee injected a couple of yeas ago an it affecte my levels.

 

[Adrienne]

Hi, sorry to hear about your bad experience. sadly i feel the care team have let you down. I have been diabetic 25 years and had my first ever operation in January. I was worried about my levels. I took my normal insulin the night before and woke up at 6am to have toast, as was told by the hospital to do this. All my levels went ok. As for your ketones keep an eye on them, if they continue call your doctor or go straight to A and E. Ketones can take over very quickly so keep a very close eye on them and try to drink lots of fluid to flush them out.

Hope you are on the mend soon. x x x x

I agree with you Smit. I think the team let Debs down too, not enough planning by far.

 

[Rubyloo]

Mornin All,

Thanks for all your thoughts! I had six Steroid injections in my back so I guess that could be the cause!
Agree with you all that I have had NO backup from the Diabetic team, the pre Ass team had to go & get a manual to give me advise re:lowering my Levemir dose & fasting from midnight! They had no idea what I was talking about & were quite abrupt & rude when I queried their advise. When I was sent home from hospital they never mentioned that the Steroid may cause any problems. I have tried on several occassions to contact a Diabetic Nurse for advise but to no avail, the Doctor did call me back but was very vague & just said up your Insulin! The Consultant told me that next time, If I have to go into hospital they will admit me the night before & put me on the sliding scale.
Thanks again for your good wishes
Debs x