Sarah Howard
Sarah Howard has worked in the diabetes research field ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
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If you have had surgery while wearing a T1D device, were you allowed to keep your devices on during the procedure? Cancel reply
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Hospitalized did all my own insulin doses. They had to use their meters so I always shared my readings and they noted it on my chart.
Consultation with anesthesiologists always good. We agreed on basal adjustments. Sometimes they don’t want to monitor patient’s blood glucose for some unknown reason and they will pressure you into allowing it to be too high. Don’t let them. Must advocate.
I’m scheduled for a colonoscopy and want to keep my Freestyle Libre on my arm, but I would guess they will be testing blood. Haven’t asked that question yet. The word DREAD has taken on new meaning for me.
I haven’t had any actual surgery but I did have a colonoscopy 3 years ago and was allowed to keep my pump on. I had a temp basal set and everything went perfectly.
Yes I was allowed to wear my pump and cgm during a 4 hour shoulder surgery. The only thing is that they insisted my bg be above 10 (180) before the surgery started. I came to the hospital with a bg of 7 (126) and they promptly gave me iv glucose!!
I think this is much less of a problem these days as more T1s have these devices and medical become more familiar with them, especially for day surgeries or procedures like colonoscopy exams. More of an issue for surgery that requires several days of in-patient recovery, in which case it’s a good idea to clear it ahead of time, especially if there’s a staff endocrinology specialist you can put in touch with your own endo (I did that with the last major surgery I had). The biggest problem I’ve had was way back when I was still on MDI and had to spend 3-4 days in the hospital after abdominal surgery. The hospital rules required all medication be administered by staff, and they insisted they were going to treat me with some horrible old-school R/N protocol. I’d recently been switched to the Lantus/Novolog basal/bolus regimen, which was like being released from prison after 20 yrs on R/N, which I loathed, so I had to really dig in my heels. That was about 20 yrs ago though. I think most places no longer do that, but I do see reports of it cropping up. Again, best practice: if it’s a planned surgery, work this stuff out ahead of time!
I had outpatient surgery two days ago. They never asked about my Libre. Since I was only there for about 6 hours, I let them screw up my BG level, then fixed it when I got home.
I’ve had a couple surgeries. For my brain surgeries, due to the length of time they were and unknown outcome – I wasn’t allowed to keep my pump of sensor on, but did have good communication with the whole team on the second one. I was on an insulin drip and was changed back over to my pump very smoothly. For my other surgeries the anesthesiologists really helped me advocate to keep my Dexcom and tSlim on. Which is so helpful with the types of surgeries I was having to had done.
I put yes, but had to advocate for myself—but it was a mix. I’ve had surgery where they allow me to have some control by wearing pump (at 80%) and CGM, and others where they refused to let me wear any of it, including them ripping off my CGM
I’ve two surgeries in the past year. first one I was told that the anesthesiologist required the pump off but left the CGM on. On the second he told me that I could leave both on but turn the pump off. In both the nurses were required to do finger pricks every one-half hour. Both surgeries went smoothly with little BG drama.
I had one surgery and I asked my endo about my pump. She said to leave it on, I don’t remember if she said to turn off the basal. I think I left it on. None of the doctors or nurses at the hospital mentioned it at all until after. Then the nurse came in and made me give them all my settings for the chart. It wasn’t a long surgery, but I wasn’t awake enough to check anything until the evening. I guess they were monitoring my BG during surgery. Now I think about it, seems like I should have asked more questions.
I had knee surgery fall 2019 and the anesthesiologist told me she really loved that my 670G system kept my glucose so level. She did 2 BG tests and found the SG accurate too.
I work at a hospital. The challenge is while pump and sensor use has become more common among T1Ds it’s still seen infrequently in the general hospital setting, so hard to have staff trained and competent to use such devices. The risk is a patient going low and the staff not knowing that insulin may be still be delivering via the pump or know how to suspend. I believe accidental deaths of this sort were reported elsewhere which prompted a lot of hospitals to change their policies. My site’s current policy is endocrinologist evaluates patient at admission and reviews settings and verifies patient is well enough to operate the pump themselves. All insulin boluses must be based on fingerstick using hospital’s meter. Pump must be removed before patient is sedated and unable to operate it themselves (e.g. surgery). CGMs do not need to be removed. Endocrinologist adjusts blood sugar management orders throughout and clears patient to resume pump once recovered from sedation.
I have not required surgery while on pump. As others mention, my mom, also a T1D pumper, has been allowed to wear her pump for minor procedures like colonoscopies and a pace maker placement.
I have had several surgeries over the last 16 years as a T1D. It’s all in the presentation. If you talk to the OR nurse and Anesthesiologist and take the time to explain the benefits and how to access current readings. This will go better.
I’ve had several procedures with cgm and pump. The key for me has been talking with the surgeon and anesthesiologists before the day of surgery. The biggest challenge is in ore-op when the pre-op nurses don’t know about T1D management. Once I downed some smarties to prep fo anesthesia and the anesthesia nurse tried to cancel surgery. It took the surgeon 20 min to get them to let me in.
I’ve always had a copy of the national anesthesiologist procedures for T1D mgmt on hand going in (on phone) and done local anesthesia for procedures. The recovery with local is much quicker, safer, under control, and being in range post.
Have had 2 surgeries with TID. Hysterectomy in 2009 was before pump. Did not go well. I passed out coming back from the bathroom and some new interns told me I was probably bleeding internally (wrong-I pass out easily all my life). I said, just get me something to eat. They brought me a bagel and orange juice. I said I needed to take insulin with so many carbs. I said I will use my own insulin pen. They said no and brought a syringe with 12 units of insulin in it. I said they will kill me. They said I had to take it all over the course of the day but didn’t insist that I be killed at that moment (fortunately). I got dressed and told the doctor I was leaving. Skip forward to 2019 with a colonoscopy and no issues. I agree more serious surgery could be an issue. You need an advocate and it needs to be someone who understands your routine. With COVID, I was so afraid of getting sick, not being conscious and no one being allowed in to help me. I agree with the nurse below who said keeping staff trained properly is hard. It is hard for any business these days.
I’ve had a couple of surgeries, the longest being 1.5hrs. Every time I was allowed to use my pump normally, but was told it would be unhooked if there was a problem.
Yes, but I was sedated but conscious during all 3. 2 were carpel tunnel surgery, 1 was a c-section. Doctors had no problem letting me leave it on. Showed nurse how to view and clear alarms before we got started.
In 2019, with cataract surgery, I had already discussed continuing pump and CGM placement with the surgeon. She had no issues with either, but when I arrived for pre-op I had to again get clearance from the Surgery Center and was required to sign additional release/consent forms.
When I met with the surgeon and anistiologist they both told me I would be able to wear both the pump and Dexcom but just before going in they had decided that because there would be a lot of cauterizing they didn’t want my equipment to get damaged so I was asked to remove them.
In 2017 I had a flawed Colonoscopy that resulted in a herniated disk in my lower spine that required surgery to correct the resulting Sciatica in my left leg.
Colonoscopy was done at one place and they said procedure wouldn’t take long so I should leave everything attached with a reduced Basal during the procedure itself.
A month later, for the back surgery, the Hospital INSISTED I remove the pump and CGM before the surgery, but during the pre-surgery consult the week before, as soon as the surgeon and anesthesiologist found out I use Insulin Pump and CGM, they both told me to leave everything attached and running and the entire surgical staff would have a meeting with me prior to surgery so I could tell the surgical staff how to do any Bolus doses or suspend Insulin on the pump and how to monitor the CGM readings, for which they also insisted I take my cellphone into the Operating Room where they said not even surgical staff are permitted to have such devices because that way, instead of one of them having to hold any device of mine or press any buttons, they could simply listen for my cellphone to verbally announce my CGM reading and trending direction every 5 minutes or so during the procedure.
I had surgery for a kidney stone years ago. I didn’t have any fight keeping my pump on me, but the surgeon put it on top of the surgical theater lights to get it out of the way. That burned out the display and severely weakened the insulin that was still in the pump.
When I had cataract surgery in January this year, the doctor wanted me to remove my pump (I refused) or lower my dosage to 50% (I refused). I went in to surgery with a blood sugar of 105 and came out of surgery with a blood sugar of 105. When he did my other eye in February he didn’t suggest that I change anything from my normal routine.
For all the surgeries I have had in the past four years, the T1D devices have been allowed, but previous to this the surgeries were more major and were not allowed; placement of grids for intrancranial monitoring and placement of responsive neurostimulator.
Have had several surgeries. Each had their own requirements. On one surgery it was basil only and nurses would do the rest, what a big fight that turned out to be. Finally I was able to convince the nurse that I’d write everything down for them if I could just do everything myself. Another surgery the anesthesiologist knew all about the system I was on and that made a huge difference!
It depended on the type of surgery. I had a couple of outpateint procedures where I was able to keep it on.
I had a couple of lumps removed and they all thought they knew what to do about my BG and insulin. They screwed it all up and then I had to show them my pump/CGM. You would have thought Christmas came early. They didn’t even know what it was before then and allowed me to keep it on because it would be so helpful! 🙄
Yes. I advocate for myself by having a discussion with the provider performing the procedure, and educating any adjunct staff on how to read the CGM. If the procedure needs sedation, I get the anesthesiologist onboard and insist I wear my devices. Most of my recent surgeries have been minor routine procedures with local anesthesia.
In both cases it was day eye surgery – no major anesthetics (groggy, but awake). Not sure a hospital would be as amenable with any major surgery.
Yes, I was allowed to keep my Tslim pump and my Dexcom on for the 4 surgeries I’ve had over the last few years. It required some talking and teaching with medical staff, MD’s were receptive and knowing I have had excellent A1c’s was a help in convincing them to allow me to keep on both devices.
I am scheduled to have a lumbar fusion done on July 13, 2021. I am thankful for this question. I have some time to research so that I can wear my pump and sensor during this surgery.
For the most recent surgery, the correct answer is both. The CGM remained in place but the pump needed to be moved to a safe distance because of RF fields. I was allowed to refuse general aesthesia and go with a nerve block instead. That allowed me to stay in charge throughout. Not for the faint of heart, however, but I found watching the whole procedure on the video screen fascinating. Clearly, this isn’t a simple yes or no question.
I just recently had a biopsy and I had no issues with wearing my insulin pump or CGM. It actually allowed me to open up conversations on how these two devices work daily to manage my type 1 diabetes.
I’ve had other procedures and it’s never been a problem to wear my devices as well.
Better than it used to be. It is usually the anesthesiologist who has concerns. Once had to “advocate” for myself when in pre-op before a mastectomy. (Yeah – great time for this; really in the mood!) The anesthesiologist insisted that my OmniPod HAD to be removed and could then be stuck back on after surgery. Eventually he called my Endo, who is the director of the hospital system’s Diabetes/Metabolic Diseases Center and of the Research Center. Guess his concerns were quickly alleviated because there were no more problems after the phone call. Smh.