Major surgery?

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Major surgery?

Postby SueM » Tue Jul 03, 2007 1:19 pm

Can anyone tell me about the sliding scale for insulin, regarding major surgery?
I am obviously going to need a lot of steroid for the surgery so how is the insulin worked out or do they just use a bog standard dose?
SueM
 
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Postby manda » Tue Jul 10, 2007 3:58 pm

ok, I had forgotten how this worked, because I haven't done this in a thousand years, but, visit this page, which explains using the sliding scale pretty well:

http://ww3.telerama.com/~moose/posts/sliding-scale.html

The formula is bg-100/x=dose. X is your sensitivity factor -- the number by which you calculate to determine what you need for a correction, for instance. It is not your carb ratio. This is how I used to calculate correction boluses, until I got the pump, which does it for me based on pre-entered numbers. Or, if you have a pump, you can just put on some temporary settings which properly reflect your needs -- I would recommend talking to a dr. or rn first in either case.

as for surgery, you should consult with a diabetes rn or doctor to determine what needs to be done. Steroids will typically drive your bg up, so your X factor will probably decrease somewhat to compensate for that. If you have a good idea of how steroids affect your bg, you may be able to calculate this ahead of time.

I hope this is helpful. I'm sorry I can't offer more information. A lot of it is based on weight, etc, too, so that needs to be considered. Good luck with your surgery!
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Postby gkardel » Tue Jul 10, 2007 4:59 pm

The anesthesiologist will most likely have you on an insulin drip and will be cheking your sugars frequently.

Glucocorticoid coverage during major surgery is 100 mg hydrocortisone given intravenously just before induction of anesthesia and contunue every 8 hours for first 24 hours. Taper dose rapidly, decreasing by half per day until reaching maintenance dose level.

Make sure your doctor briefs the surgeon and anesthesiologist on what needs to be done.

Glenn
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Postby SueM » Tue Jul 17, 2007 10:21 am

Hi everyone, and thanks for the replys Glenn and Manda.

Things went pretty well with only 2 hitches.
1 was resolved very quickly with the help of the diabetes nurses. They wrote out a new sliding scale for my drip which was in place for 3 days.
I was running high for too long and obviously going higher when more steoids were introduced. My ratio was doubled which worked wonders.
The staff were fantastic and listened to my requirements and as soon as I was able to eat I went back to managing my own diabetes.
When I went down for my op I was given 200mg HC and then 100 mg HC every 6 hrs untill I was eating and could take meds by mouth. This worked very well for me. I was then given double steroids for 48 hrs and then down to normal dose.
Then the fun (not) started

I started to feel unwell on the Saturday evening told the staff nurse I needed more steroids, she was fab got the Dr up to me straight away problem resolved.
Then Sunday morning I threw a massive temp and started to vomit, blood sugars went down too 2.9 (52) so asked the sister on duty to get a Dr asp as needed steroids urgently. She ignored my request and an hr later mentioned in passing to a Dr that I had been sick and was moaning 8O I wanted more steroids.
It was just as well I had some steroids hidden in my locker because I would have been dead by now.
As soon as the Dr heard what the Sister said she came at a gallop to my bedside. She again was fantastic and called in the top guns
I have the impression that Sister will wish she had never been born.

I have suggested to the consultant that a special notice needs to be put in peopls records if they have addison's disease detailing when to give extra steroids so the problem does not arise again.
I was lucky because I am so proactive with my own care I could help myself. Someone else might not have been so lucky.
The tumor that came out of my belly weighed aprox 3kg 8O
The consultant was amazed as to how well I have done and said it was a pleasure to deal with someone who looks after their diabetes. So far no infection and wound has healed a treat. Not bad for someone on insulin for 42 years :)

The staples come out on Thursday morning and fingers crossed I will back to normal within 3 months :)
SueM
 
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Postby gkardel » Tue Jul 17, 2007 10:51 pm

Sue,

Wow, a 3kg tumor. You must feel relieved to have the operation over with. Did they explain the reasoning behind the steroid regimen for your surgery? How long did it take unitil you were able to eat? Reducing your steroid dose from 100mg every 6 hours to a doubling of your maintenance dose sounds like they tappered too quickly. This may have caused the difficulty you experienced over the weekend. That was smart of you to bring that steroid stash. Sounds like you're doing better now and on the road to recovery which is great.

Glenn
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Postby SueM » Wed Jul 18, 2007 9:29 am

Glenn,
I was able to eat on the Thursday morning with no problem I had my op on the Tuesday morning so basicaly 48 hrs on the high doses of steroid.
Then another 48 hrs on double maintenance. Like you I think the tapper was too quick. Once problem sorted I just had an extra 5mg pred for 24 hrs and felt fine again. I am now on normal dosage again and doing well.

I am very tired but then after being in surgery for 4 hrs and having goodness knows what removed it is hardly surprising.

I have no idea why they all decided on the amount of steroids I needed but they were not far out just the last day was a bit of a problem. But at least I now know that the tapper was a bit too quick for the last day.
So if surgery is ever needed again better plans will be in place for me.

Sue
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Postby SueM » Wed Jul 18, 2007 11:29 am

Oops slight typo extra 5mg HC that should have read.
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Postby manda » Tue Jul 31, 2007 1:39 pm

Wow. You ARE SMART!

I hope you start feeling better right away!
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