I am due to have surgery under GA.
During 2022 I found myself in hospital 4 times, 3 planned and one an emergency needing rapid surgery. My experience has been that there is a pre-op assessment a few days before final admission and that pre-op assessment provided detailed instructions about insulin preparations.
I currently inject 18u Levemir basal when I get up with Novorapid before meals. There are a couple of things I'm concerned about:
* The day before surgery I cannot eat or drink after midnight. I assume that on the day of surgery I don't inject my basal insulin?
In principle you should still always need your basal. It's the background insulin that helps you manage the glucose releases that your liver does as part of daily living.
The hormones cortisol and adrenaline trigger the liver to release the stored glycogen (= glucose); these are instinctive responses by the body. Other people, who don't have damage to their pancreas, also get glucagon released by their pancreas which is a messenger hormone activated by our brain when the brain has detected our glucose is low; that glucagon travels to the liver and tells the liver (on behalf of the brain, which can't talk directly to the liver) to open the glycogen store. All these glycogen (glucose) releases are outside of glucose coming from carbs that you've eaten, which need bolus insulin.
You might get advice to reduce your basal by a modest %; but be prepared to challenge any pre-op assessment that tells you to stop all basal. It happened to me and I had to advise the pre-op nurse her guidance was incorrect! She checked and agreed.
* Hopefully after surgery when I come round from the GA I will be taken to a ward. How will the hospital manage my insulin? I'm worried that I may not be able to eat solid food (intestinal surgery) for a couple of days.
This is difficult. In theory the Hospital will know what they are doing and entrust your insulin care to the anaesthetist for the duration of the surgery and he / she will probably encourage you to agree to be put onto a "sliding scale" protocol. This is a defined procedure, which should be specific for you personally and put as a written record on your ward charts, defining the circumstances when you should receive extra glucose from an intravenous drip at defined rates or extra insulin from a drip at defined rates. This is fine during the surgery - the anaesthetist will be monitoring all your vital signs minute by minute and will be ready to tweak as necessary. I wore my CGM sensor throughout and as well as getting readings onto my phone, I had a Reader which I had with me during the Surgery and was lent to the Anaesthetist for the duration while in Theatre. That worked well.
*There is the possibility though I may be in critical care and I'm worried that I may be on very strong pain medication that makes me too "out of it" to ask questions, double check that I'm being given correct insulin doses etc.
*While in critical care you should receive the same diligence and care as you receive while in Theatre.
* In the past (before I became diabetic) when i had surgery I was fed by nasogastric tube - How do I manage my insulin in that circumstance?
The challenge starts when you are back on the ward and returned to the monitoring of a nurse who does not always have the right skills. As soon as you are sufficiently alert to resume your own insulin care I strongly suggest you get yourself taken off the sliding scale insulin drip.
*I was not on a nasogastric tube after my emergency surgery, only after my Whipples procedure while in ICU (and well out of things). I would interrogate your Surgeon and your Anaesthetist about how this is done, including precisely what the nutritional content of that feed will be. Almost certainly it will be a medicine from Pharmacy, rather than part of the Hospital catering contract and nutrition details can be found, but it probably won't be easy. I guess you will need to stay on the insulin drip.
Before signing your agreement to go on the sliding scale read the detail carefully. My "written protocol" that I signed without reading and properly understanding it, had a a blatant mistake stating that when my BG was very low I was to be given insulin (not glucose). Most luckily my CGM low alarm was doing its fair share of screaming at me after I was back in the ward; I had just come round and pressed my buzzer; a nurse saw I was low BG, read the protocol and said I needed more insulin (as written down!). I was woozy but awake enough to say no - she said yes, it was in black and white. I had to very robustly say no and insist I was immediately taken off the sliding scale apparatus. There was an argument, I ate some hypo glucose response from my bedside stock and went back to sleep. But if I'd not been alert, the Nurse was following the written protocol with no understanding of what the instructions were wrongly telling her to do. And I had signed my agreement to the Hospital error put on my chart by the Hospital Endocrinology Dep't.
Once you are moving from nasogastric feeding back to solids the carb content of the hospital meals are atrociously poorly documented. I did find out that Hospitals do have very detailed contract agreements for precise nutritional content of all meals being provided by the Catering Contractor. The problem is that this sort of contract detail is "a Secret", that no one wants to share with ward staff or patients!! Once I found it existed I gradually got others to understand that it was available - even though they had never seen it - and eventually show it to me. This was a challenge, but I had the time and "bloody mindedness" to acquire the information.
I'd appreciate any advice or experience from others. Many thanks.
Good luck.
