Surgery and Pumping

Technology & Management
1

I'm new to this forum and will be having an outpatient surgery on my hip in a few weeks (hip arthroscopy).  I have type 1 and wear an insulin pump.  I also tend to be sensitive to insulin -- for example, when I have nausea/vomiting and can't eat, I need to significantly reduce and/or turn off my basals to avoid going low. 

I would appreciate hearing from anyone who has had minor surgery about how they handled the pump.  Did you disconnect during surgery?  Reduce your basals?  Did the hospital monitor your blood sugars during surgery?  

Thanks in advance.  

2

I have had a colonoscopy while pumping, and I was allowed to use my pump while they monitored my blood sugar during the entire procedure. My doctor verified that my control was good, and I should be safe while using my pump. If your doctor will do the same, then you should be able to depend on your pump during surgery. If, however, your sensitivity to insulin and your control results in frequent lows, then you probably should not use the pump at that time. Even the anxiety caused by surgery can make some diabetics have unstable blood sugar. If you disconnect your pump and let them monitor during the surgery, they can give you glucose as needed to keep you from going low. I was permitted to use my pump ONLY because my pump control is very stable and the colonoscopy did not cause me any concern at all.

3

I've had a few surgerys while i was on the pump. All of them I kept my pump on and didn't make any changes. While I was under anesthesia the doctors monitored me and checked my blood sugars frequently and all went well. If you know you have a tendency of running on the low side i would lower your basal rates and just let the doctor know. Also let them know what kind of insulin your taking and your correction if anything needs to be changed while your getting your surgery.

4

I had arthroscopic shoulder surgery in November.  I kept my pump on but reduced my basal rate (I also made sure the surgery scheduler knew I had type 1 and needed the 1st appt of the day (since you can't eat, etc for 12 hours before)).  So I reduced my basal rate before we left the house in the morning.   My endo wanted me to try to be around 150 before going into surgery.  The anesthesiologist kept my dexcom CGM receiver in his pocket while I was under - they LOVED it.  

Talk to your diabetes doctor to get specific plan on how to handle.  

5

I've had arthroscopic knee and shoulder surgery over the past three years while on the pump.  I offered to reduce the basal rate by 1/2 during the surgery, and the doctors agreed.  As long as your blood sugar just before surgery is in the normal range and not dropping, it should be all right.  I'd carry a few sugar packets and/or juice boxes - just in case your blood sugar begins to trend lower, you can stablize it before the surgery begins.

6

[quote user="MarkO"]

I've had arthroscopic knee and shoulder surgery over the past three years while on the pump.  I offered to reduce the basal rate by 1/2 during the surgery, and the doctors agreed.  As long as your blood sugar just before surgery is in the normal range and not dropping, it should be all right.  I'd carry a few sugar packets and/or juice boxes - just in case your blood sugar begins to trend lower, you can stablize it before the surgery begins.

[/quote]

I agree that most doctors recommend a 50% basal for times you aren't eating (like surgery), although you should check w/ your endo about your own situation. But, I wanted to add that most anesthesiologists don't want you drinking juice before surgery. So, if you're low, check about what they want you to do (clear juice, dextrose drip, postpone surgery, or whatever....).

7

I’m going to have knee surgery for a meniscus tear next month. I’ve been planning my strategy for BG control. When I had my colonoscopy, I wore my pump and CGM and just reduced the basal. All went well. But, this time I happened to look at the Medtronic manual and it says not to use the pump around oxygen. I suppose there is oxygen in the operating room and it could be used, it I had an emergency. So, I was wondering if anyone has ever heard of that being an issue. I know a lot of people who keep their pump on……oh, I’ll be having a block and sedation, not general.

8

Hello @HighHopes , wow this is an old thread! Anyway, no, oxygen is not a problem. Step 1 - Talk to the surgeon. I asked to be 100% in charge of my sugar and they agreed and wrote it in my chart. This allows me to give insulin and test blood sugar in recovery and in pre op. On the day of surgery they may bargain with you to reduce basal and shoot for a number like 150. Anyway they can raise your blood sugar with iv dextrose in like a second.

I’ve had 2 surgeries. No problems wearing the pump in either one as long as you have agreement with the surgeon. Good luck :four_leaf_clover: and speedy recovery.

1 Like
9

@HighHopes all the best to you on your surgery.
To add a bit to what @joe said - my recent surgeries have been under local or twilight sleep but years ago I had a procedure where they put me under. As they were preparing to wheel need in I gave a quick crash course in how to read my CGM and instructing them what to do if my numbers dropped or went high - only to be told they could only take that direction from my Endo, not me(:bangbang:). It wasn’t likely we could get that on the spot and I didn’t want to cancel at that point so I went ahead and basically hoped for the best. All of that is to say, you might need to involve your Endo so allow some time just in case.

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10

Thanks for the input. I’ll bring it to my Endo’s attention.

The intake form from surgery center asked some questions about pump vs, injection, but the boxes didn’t allow proper response. I’ll supplement it. Am having pre visit, too.

The way the 670G manual words it, it seems that oxygen could impact the device. I can’t image that, but….maybe just for precaution sake. I also wore it into operating room when I had eyelid surgery. No problem. Pretty sure there was oxygen around, though I didn’t get any.

11

@HighHopes the manual warns “Do not use the pump when a flammable anesthetic mixture with air, oxygen, or nitrous oxide is present. These environmental conditions can damage your pump and result in serious injury.”

Flammable mixture.

So directly exposing the pump the nitrous oxide such as if the pump were in the face mask, would damage it. The probability of the area around your waistline becoming flammable would be incredibly rare if not impossible unless there was a catastrophic failure of the pressurized gasses in the OR and if that happened, pump damage would be the smallest of your problems.

I think the pump is going to be fine. Good luck.

1 Like
12

Yaayyy! I just knew it! Thanks for the explanation. Makes sense.

13

@joe you continue to inspire my thoughts! I use nitrous for dental procedures and have never had a problem; and people wear their pumps on planes which have emergency oxygen as well. I suspect the exposure would be more direct, as you suggest - I imagine you would have to remove it if you were going into a hyperbaric chamber, where any tiny spark caused by friction could cause an explosion.
So not to make light of the warnings but I think they word them to have the greatest impact. Your discussions with the surgeon and your Endo should clarify things.

1 Like
14

I’m glad you commented on nitrous, because I have been considering using it for wisdom tooth extraction.

15

For ALL I have an anesthesiologist for a neighbor. When I needed several anesthesia procedures in the past since being on Tandem’s CIQ and before when on brick pumps with Dexcom CGMs of various vintages, we created this handout.

References are for Tandem/Dexcom combinations. Other pump users should be able to find comparable items to replace the Tandem references.

Hospitalization or procedure - revised

Who are the people to work with for a procedure or surgery if you wear an insulin pump and Dexcom G6 Continuous Glucose Monitor (CGM).
· Surgeon or physician performing the procedure.
· Anesthesia staff (anesthesiologist [an MD] or anesthetist [specially trained RN] or person responsible for monitoring your vital signs (EKG, BP, Pulse, etc.) during the surgery or procedure.
· Endocrinologist who monitors you, your pump, diabetes, etc.
· Facility CDE, if any, should be able to support facility staff caring for you and be knowledgeable about the technology.

Work with your surgeon, endocrinologist, and anesthesia team. Every time I have a procedure, I start with my anesthesiologist. She arranges my anesthesia care with either an anesthetist or anesthesiologist or both for some long or complex procedures.

Starting about two weeks before the procedure, the anesthesia team works with the surgeon to identify the operative area both for incisions as well as imaging (ultrasound, etc.) areas. Remember, CIQ & G6 should not be exposed to x-rays, sometimes called a C-Arm. In some situations, lead apron shielding may protect the CGM & CIQ from x-rays. This is not discussed in Tandem literature.

This early planning with the surgeon and anesthesia allows for placement of the CGM properly and time the pump site change and location so the (1) site is fresh, (2) pump is full, and (3) in the best or agreed upon position. Make certain all sites are in locations consistent with best practices. A CGM on an arm may need to be removed because it interferes with blood pressure cuff placement. Use the longest tubing possible for pump site sets. Long site set tubing allows the anesthesia team to move the pump about their workspace. Thought, the anesthesia team usually is near the head during a procedure. Think about a pump site that would allow the pump to be near your ear.

On the day of surgery, the CGM should be compared to a STAT or rushed preoperative blood chemistry including a glucose. The CGM reading at the time the labs were drawn should be noted and shared with the operative team. Review with anesthesia the pump, including how to read the CGM from the pump, and treat elevations reported by the CGM. Having the primary anesthesia staff practice with a bolus of 0.05 units puts everyone’s mind at ease. Using 0.05 units for the practice bolus is so small as to be negligible in most individuals and is the smallest the Tandem X2 pump will deliver.

Assembled below is a collection of documents to support the way a health care team should do things with the CIQ enabled pump & CGM.

These links are for the documents recommended for printing for planned hospitalization or an outpatient procedure. It may be prudent to have up to 5 copies of some documents for placement and review by selected team members. Ask for a pre-procedure or pre-operative visit with the anesthesiologist to review how the pump works. Show and ask for a return demonstration of bolus administration. The ideal dose in this situation could be 0.05 units (the smallest CIQ will give). In an adult, this is almost a non-therapeutic dose.

Control-IQ Technology –
what CIQ & CGM do working together

View System Status with CGM

Administer a bolus
https://www.tandemdiabetes.com/docs/default-source/general-guides/ml-1004690_a---print-flyer-quick-reference-sheet-deliver-a-bolus-canada-web.pdf?sfvrsn=aaf836d7_26

Load a Cartridge

AutoSoft™ XC Instructions for Use

Tandem Documents & Resources

If another site set is used, there are links on the Tandem site to use in place of the AutoSoft site set above.

If needed, the easiest way to get to the Tandem Documents & Resources is a browser search with the terms TANDEM DIABETES SUPPORT DOCUMENTS

16

Very helpful and informative information. Thank you and your neighbor for all the work that went into it!

17

I hope yours goes as smoothly as mine did. I had always imagined it would take a couple of hours (don’t ask me where I got that idea) but it took less than 30 minutes, and I was able to walk out with my husband another 15 minutes or so after that! Relaxed the rest of the day and cent close to 100% the day after😊.
Some people have their teeth removed while awake but I requested to be put under anesthesia because I’m a dental coward; so rather than nitrous they put me in twilight sleep via IV.
I went to a couple of dental surgery practices for a consult on the removal but they declined me, saying it was because of my diabetes, bp and age. BP is managed well but they couldn’t/preferred not to manage my blood sugar during the procedure so I had it done at the hospital where my endo has her office. That may not be an issue for you but I wanted to mention it in case you need to make those toe of arrangements.