My son will soon have abdominal surgery (pyloroplasty for severe gastroparesis) and has just relocated his Dexcom G6 sensor to his left arm since the stomach has to be avoided. He doesn’t know where to put his Tandem Trusteel 6mm cannula.
He is slim and has only been inserting it on his stomach. He uses CIQ. We are sure he’ll need a blood pressure cuff on one arm during surgery and recovery.
Any suggestions for placement other than the abdomen for both the G6 and 6mm pump needle? Thank you, Brenda
I recently placed my G6 on my upper thigh. It’s not one of the approved sites but I didn’t have any problems. I don’t use the steel cannula but since the thigh is a fleshy area perhaps it would work there.
BTW, Tandem told me they would replace sensors if I had to have xrays/radiation procedures. I used to time my site changes to coordinate with scheduled procedures like that, so it was nice to find out. Check for yourself to confirm.
I hope everything goes well!
Check with the surgeon and anesthesiology. Use the time with anesthesiologists to teach them and recovery room nurses about CIQ. Try to do preop visit several days early. Take Tandem handout about CIQ so they will know about all the whistles and bells of CIQ.
When I had surgery many years ago, just before they started the anesthesia I told them how to read my CGM and what to do if my blood sugar started to drop. They said they could only take instructions from me diabetes doctor/endo😳, and given that I was about to go in that very moment, that wasn’t going to happen - I would either need to take my chances or postpone at the very last minute. Not wanting to delay I went on. I did go low, and after what I gather was an injection of glucagon I woke to a nurse taking me and calling my name.
I certainly don’t want to scare you but I do believe in being fully informed. The general medical profession has only a textbook understanding of diabetes - not the intensive type our endos have. So where surgery is concerned, have your doctor provide those instructions to the surgeon who will be doing the procedure. And maybe take a copy with you to give them before you go in.
I’ve had a few procedures, only one of which required general anesthesia; but I keep this in mind if I ever need another one. The G6 adjusts to manage highs and lows, but surgery may require more effort.
@Bbtauer hello and welcome to TypeOneNation. When I had my appendix surgery I had my pump site at the top of my butt which ended up being fine for a surgery which involved my abdomen (4 micro incisions). The much larger issue is having the surgeon agree, in advance, that he will be in charge of insulin and blood sugar control and to write it in his chart so all physicians and post op nurses know the deal. Hospitals need this instruction to even allow a patient to have their own medicine and equipment. It’s easily solved though. Good luck and speedy recovery.
@Bbtauer Hi Brenda, and welcome to the JDRF TypeOneNation Forum!
I understand the situation your son is in, especially because he is, like me, slim and using CIQ. I was fortunate when had bi-lateral hernia surgery and had to keep my abdomen clear that I wasn’t using a CGM or CIQ. Seeing that he has planted his G6 on his left arm, and that almost all surgery protocols demand a blood pressure cuff on an arm for intermittent monitoring, I suggest that he place the 6 mm Tandem cannula on the upper side of his left butt; I’m suggesting ‘left side’ so as to free up his right side for the connections to the BP cuff and the 12 lead monitoring system.
As @Joe suggested, the big chore might be educating surgeon and anesthesiologist. I was fortunate that my four surgeons, for different procedures, were mostly understanding when I TOLD them that my insulin pump would remain in place and active before, during, and after surgery and that i would be “in-charge” of my diabetes. I did have to educate a couple of the anesthesiologists and CRN-A.
I hope all goes well for your son; please let us know how he works this out.
This is an amazing community to have this many responses overnight! My son was diagnosed T1D 18 years ago at age two.
Based on your suggestions, he says he is onboard to go with the CGM on his left arm and pump site on his left upper buttock. He will have at least two pump site changes to practice with and one more CGM change before 7/22/2020 surgery.
As far as managing his diabetes during the operation, he says he will suspend his pump as he has previously done for numerous endoscopies and BOTOX treatments to the pyloric sphincter at the base of stomach over the past two years. In light of the COVID-19 atmosphere, the hospital is not allowing parents in and as a 20 year old, he is not wanting to take it upon himself to educate the hospital staff. He is so nervous approaching next week’s surgical date. The diabetic gastroparesis has been brutal these past two years. Thanks again.
Ah, so he has some experience to guide him. Unfortunate thigh that is, it is a plus as is not completely new to him. The prep visit and handout @987jaj recommended may ease some of his tension about training the staff although I do wonder what specific training you are referring to?
I often times put my pump site on the back of my hip / side of my lower back. I’m thin, but I have a little bit of fat on my hips and it creates a great spot for my pump site. Maybe that could be an option?
@Bbtauer Brenda, I agree with you about the vitality of this TypeOne community. I first joined [the old] TypeOneNation about 2003 when it was begun by a young lady in New York who was feeling alone in her diabetes and wanted to talk with other like herself. Because of heavy work-schedule I dropped out of the site and didn’t return until after I retired - loving it ever since.
As for your son, his personal experience should be an effective guide for him and continuing what he had done may be what is best. My experience, following a few surgeries before I began using a pump, my BG was often too high after I awoke, so I find that keeping insulin running during surgery is my better option. To play-safe, a few days before my current surgeries with a pump, I will minic surgery day, make appropriate settings on my pump, and go without eating for as long as I anticipate I’d need to be “clear-thinking” after my surgery. A dry-run, so to speak.
@OcelotKitty My son appreciates your comments and is planning to place the pump on the backside as you suggest. Where would you suggest he place the CGM knowing that the abdomen has to be clear?
Also, he doesn’t want any physical assistance so just curious, is it easier to use the the right hand to place it on the right hip/buttock or right hand to place it on the left hip/buttock?
I would do the upper arm, on the rear side, for his Dexcom. Do the arm of which he prefers the IV to be placed and opposite of the arm that the blood pressure cuff will be put. The doctor won’t usually put the blood pressure cuff and IV on the same arm. So, if the Dexcom is on the same arm as the IV, the other arm will be available for the BP cuff.
I use my right arm to apply the site to my right hip and left arm to apply the site to my left hip. That way, I don’t have to twist too much.
I hope the surgery goes well. Good luck with everything!
I’ve never inserted my pump or CGM on my rear, largely due to the way I like to sit and because I sleep on my back. I always wondered how people manage that insertion on their own, and I have to say the G6 is much easier and can be done with 1 hand.
I am having a laparoscopy surgery done for endometriosis and I have my CGM above my navel to the right. Is anything they are going to use going to compromise the transmitter ? I am not having my stomach cut open it’s just too too for small incisions but do I still need to worry about that since my CGM is on my stomach area still ? One incision is in the belly button and then there can be 2 to 4 around stomach. I’m assuming that my transmitter is not going to bother that ,but I am concerned about it being compromised by any equipment. Is this something I need to be concerned about?
@My4babies88 - I wore one during hand surgery many years ago and I don’t recall any problems - it was a fairly short procedure done in an OR with local anesthetic, FWIW. But you should run this by the rep for your CGM as well as the surgeon in advance.
There may be rules about “foreign objects” being brought into the surgical suite that might require clearance." I confess I’m brainstorming here and could be off.
I’m a huge proponent of managing our own care but (as an aside) I learned a while back that my physician had to provide instructions on what to do if I went low or high during a procedure. Before they put me under for my hand I have them a quick lesson on reading my receiver (which they allowed in the room) and told them what to do in either instance. It was then that I was told my endo had to provide those instructions. I could go on as planned or reschedule (I guess contacting the endo would have taken too long). I went ahead and all went well; but let your surgeon know what to do for highs or lows, so they can let you know if that info must be provided by your doctor. I don’t like it but doctors want to do all they can for their own safety so in my experience they like to talk to each other.
So check with your rep and surgeon about your CGM, and let the surgeons know about handling BGS. It may be they can take instruction from you but best to know in advance.
