Tips for a Winning Operation with a Pump – by Helen May
Thankfully, I experienced no diabetes complications during my recent surgery. I believe this is greatly due to preparation and communication. So, I wanted to share my tips for a successful operation with an insulin pump.
Tell everyone you have an insulin pump
There are lots of options for listing current medicines and those doses (which is not easy for insulin) and there is usually a question whether you have diabetes (but little chance to explain which type). However, unless you say, it will be assumed it is treated with basal-bolus injections.
Tell your diabetes team you are having an operation
Although my surgery was at a different hospital to my diabetes team, I still contacted them to tell them what was going on. They were able to answer diabetes specific questions and provide some hints on how to manage your blood glucose and surgical team. They also offered to come and see me and the surgical team on the ward but this was not possible.
Practice explaining how the pump works
Insulin pumps are not very common. Therefore, the surgeon, anaesthetist, nurses, physiotherapists, etc. may not understand what it does. I found a simple explanation about the ongoing basal and dialling up carbs for my meals gave them confidence in something some were frightened of: fear of the unknown is big when they are responsible for your life.
Work out where to put your pump and cannula
In my case, the surgery was to be made to my abdominal area. This is the area I usually put my cannula so I had to work out an alternative which I discussed with the surgeon and my diabetes team. We agreed to put it in my “back tyre” which is unusual for me.
The anaesthetist and I also discussed where he could put the pump out of his way but still within sight during the operation. He was able too position it near my shoulder because the tube was long enough and I am not very big.
It is also worthwhile considering where you will put the cannula during recovery. With wounds in my abdomen, and only two areas on my back I can reach, my options were limited. In discussion with my diabetes team, we agreed to use the top of my thigh. This is not usually an option as I walk a lot which affects the absorption. However, during my recovery, I would be resting.
Make sure you have plenty of supplies
During recovery, you may not want (or be able to) pop out to pick up a prescription. So make sure you have enough insulin (you may need more than usual because you are not exercising) and test strips (you may be testing more than usual).
Pack lots of supplies
Just like when you go on holiday or go on a business trip, make sure you have a couple of set changes with you (or more depending how long you will be in hospital). Even if you are not expecting to stay in overnight, take a spare set just in case.
Make sure you have plenty of insulin in your pump
The last thing you want is to run out of insulin and have your pump alarming during the operation. So make sure it is as full as possible.
Make sure you have plenty of charge on your battery
Just as you don’t want to run out of insulin, you don’t want your battery to run out.
Ensure your pump is working correctly
In order to have as much insulin and battery power in your pump, you may be tempted to do a set change just before you leave for the hospital. However, if you are anything like me, you will be nervous. And, when I am nervous, it’s as if my pump knows and the cannula does not go in correctly or the tiniest weeniest air bubble gets in the way or something else goes wrong. So give yourself plenty of time, before your surgery to test everything is in working order.
Don’t be surprised by higher blood glucose
Yes, just as you are looking for your blood glucose to be steady to check your pump before your leave home, you are nervous and your body is stressed. So your blood glucose may be rising.
And, following surgery, your body may produce extra glucose to help repair itself. Combined with sitting around doing not a lot, this may result in a higher blood glucose. You may want to do a temporary basal.
Prepare your fingers
They will be pricked a lot. Before the surgery, they will want to check you are not going hypo and hyper; during the surgery, they will keep taking readings; after the surgery, they will want to make sure your diabetes is under control. For me, this meant being woken up every hour throughout the night to prick my finger.
Finally, don’t worry
The surgical and ward team are there to look after you. You may know your diabetes better than them, but they will make sure you are not at risk due to a problematic blood glucose. They may not know your pump and may not want to take over control of the pump, but there are other options via a drip.
Surgery is a major undertaking but just like diabetes does not have to stop you climbing a mountain, perform a piano concerto or chair an important meeting. It does not have the stop you having the treatment that should make another part of your health better. It’s there all the time but it can be kept under control.