Tonsillectomy

Parents
1

My 20 year old son is having his tonsils removed in a few days. Any advice for managing his blood sugars (he’s on a pump) as well as his pain?

2

Hi Kelley @40kelleya, first let me extend a warm Welcome to the TypeOneNation forum!

I am not a medical provider so any comments I offer are based solely on what I have learned and experienced during my more than 60 years living with diabetes. In recent years, I have had several surgeries requiring total anesthesia. My first suggestion, and this is important, is that your son speak with both the surgeon and anesthesiologist before surgery and he will tell them, insist, that he will manage his insulin and wear his pump during surgery. Many hospitals / surgery centers tell people with diabetes NOT to take any “diabetes medicines” on the day of surgery - that directive may [or may not] be proper for persons with “lifestyle diabetes” but it most definitely is not proper for autoimmune [TypeOne] diabetes. The two hospitals and surgery center in my area have now modified their procedures for us with TypeOne.

You mention that your son uses a pump but you didn’t comment on how well he has managed his diabetes. I will assume that your son will need to refrain from all food and drink on the day of his tonsillectomy and that he has managed his diabetes appropriately and understands his pump - all pumps have the features I will reference.

  • On the day before and on the day of his procedure, he must monitor his glucose levels several times and record trends;
  • He should use either a pump pattern/profile or a temporary basal of less than 100% for the day of procedure;
  • His BGL [Body Glucose Level] should be slightly elevated, but not too high, in the hours leading up to the procedure - I aim for 140 - 150 mg/dl.
  • During the prep, he and/or the techs/nurses should check his BG a couple of tines - take additional insulin, but not too much, if he begins to rise;
  • When he awakens, or even before he awakens, a BG check should be done and depending on results either food or insulin could be appropriate.

Keep in mind that the stress of the procedure - both physical and emotional stress - will affect his glucose level. Also, dawn phenomenon will tend to push up his BGL.

Good luck to him. Now have him join this site, we would welcome him here.

3

Dennis,
Thank you so much for taking the time to offer your advice. I will share with my son and suggest he join this site.
Much appreciated!

4

Hi Kelley, One more thought, also consult with his endo, or the doctor who handles his diabetes care. When I first went on a pump my endo told me to tell the doctor/nurse not to adjust my settings. The first thing the surgeon wanted to do was to cut my basals to 50% because they were worried I would go low during the surgery. I told them what my endo had said and asked them to call her. They left my basals alone.
Every person with T1D is different, and every treatment plan is different. So, I definitely feel the endo should be involved.

Pam K
T1D 54+ yrs and counting!

5

Yes Kelley @40kelleya, Pam’s @pamcklein advice to get the advice of your son’s endocrinologist is important; I too have discussed this with my endo when developing my procedure.
Another thin I do, when I have advance notice is needed surgery, is to do a “practice run” a few days prior to make certain my pump basal settings, along with any temporary basal adjustments, actually give the needed BG results. This is similar to overnight "basal rate validation, where I eat a normal evening meal and then do not eat again until after lunchtime the following day; I do this validation with every change of season.