What do I need to know about t1 and anesthesia? I’m going to be put under soon, probably Sunday, for a minor outpatient procedure (ivf egg retrieval) and have no idea what to expect. Procedure should only take 30min or so…
I’ll charge up my dexcom transmitter so they can look at it if they want to… My basal is pretty well locked in so I don’t expect to drop while fasting but I might reduce it by a unit just to be safe. I’ve had anesthesia before, just not as a t1.
Any experiences or tips?
CarolynA, important question, do you know what type of anesthesia they are going to use, and how long the procedure lasts.
i.e. general anesthesia with a paralytic agent, is vastly different than conscious sedation with Midazolam and Propofol.
30min and I’m sure just conscious sedation (at least that seems normal for this, don’t know about my clinic specifically)
I am sure a number of our diabetics have had conscious sedation and will be along shortly, I don’t think you will have to do anything really. You may want to give your receiver to the person delivering the anesthesia, along with very specific instructions about what you want them to do. You will probably recover from this really quickly, although if you have a trusted friend hanging out with you in recovery you should be fine.
You will need to be NPO for eight hours prior, so planning is important.
You need to adjust your basal far enough in advance so that your fasting Bg is stable and, ideally, about 140-160. The worst thing that can happen is if you go to low, they’ll have to hit it with IV glucose and you’ll end up skyrocketing. (Been there done that).
You don’t have to worry about your Dexcom during the procedure, they won’t even look at it. The anesthesiologist knowing you are taking insulin will monitor you via finger stick a couple of times during a half hour procedure to make sure you’re not crashing.
Basically, just prepare, then relax and let the docs drive the car.
I had general anesthesia for a laparoscopic cyst removal in December. I kept my pump on throughout the procedure (and actually, the nurse anesthetist showed me her pump before we started, so it was neat to know she understood). Two problems I had:
My top tip is to check what is in the saline bag. I had one surgery where there was dextrose in the saline bag and it made life interesting. I woke up feeling high and tested and I did some 1/2 asleep calculations on how many carbs/hour were going in to my body and was bolusing for it. It never occurred to me to ring the nurse and ask her to change the bag. When I was a little more conscious I did ring and the bag was changed and it was more peaceful 
As @docslotnick said - going in around 140 is not a bad idea as it gives you some room to drop if something happens.
Wow, just wow. The things you shouldn’t need to check, but still do. Having a with it advocate is probably the best advice, but that makes me depressed to hear about.
That is inexcusable on the anesthesiologist’s part. He is responsible for the drip bags and if he doesn’t know how to treat a diabetic patient he shouldn’t be practising.
But in reality, they are just interested that you stay under 300 and above 140 during the procedure and could care less what you need to do after you wake up. They figure that even if you are at 3-400 for a few hours it’s not going to kill you, but if you are hypo during the procedure, well, that can kill you.
@CarolynA, I have read numerous horror stories about hospital mismanagement of PWDs, where many people swore they would never go to a hospital unless a close family member were there with them. @Aaron’s story about a dextrose transfusion bag does not surprise me at all. We do not have personal experience of it, but, after reading them, I decided that I would make sure that (a) one of us was with my son anytime he was treated in a hospital, and (b) I would ask about EVERY substance that got into my son’s body before it was injected.
Your being hopefully conscious all the way through makes this less of an issue! Is there a chance a friend of yours could come with?
Thank you! This is very helpful. I will go in mid-100’s if possible so they don’t feel the insane need to give me an amp of d50 which would send me to the 300s for sure and I will make sure there is no dextrose in the iv bag.
I really don’t like relying on my friends for things but I’m going to have no choice about a driver… Sunday would be better for that than the originally projected Tuesday. And I’m still considering biking to the clinic and having a friend just pick me up instead of both drop off (and come in with me?) and pick up… Ugh. I KNOW I have friends that would be willing to be with me but still… I feel like I need to bank and acculate all that goodwill time until I actually have a child.
I’m so independent by nature. Hence the donor sperm. But I’m super glad I’m doing this now because I don’t have as much time as I should age-wise and I probably would have had to do ivf anyway even I had a willing boyfriend/husband…
I’ll keep you guys posted based on any updates I get from the clinic and dex graph after. I’ll have to go thru this again next month (embryos this month, maybe more embryos maybe just eggs next month depending on how many pgs normal ones I get this time) and then again after that for a hysteroscopy before they’ll let me implant anything.
@Michel, I’ve head the horror stories too… At least I’m just outpatient and its a short procedure. But even on my initial 4-day dka stay on the endo floor, I was 200-400 the whole time. For the rest of all this (birth etc a year from now, I plan to refuse diabetes-related care when conscious if at all possible, but I think that that is easier said than done especially since I’ll be alone and in pain. I’ll be sedated this procedure so won’t be entirely possible, but I’ll do my best.
Just going to throw out there that as a child-free friend of many women who now have children, it’s really nice to be able to help my friends when they need it. I’m a rocking Auntie, and I love that job, but I also like to help the women I know and love. And I’m sure that you’ve got a friend who feels the same.
Letting people help you is actually an act of generosity. They get something really good out of helping you too. 
Thank you that is really good to hear. I really do have A LOT of friends and I know they would do plenty for me. Its just nerve wracking to actually ask and need help. Even though I’m happy to help in return.
Please ask, and if they are true friends, they will expect nothing in return.
I’ve been put under several times… just discuss your concerns with your doc (and/or the anesthesiologist if applicable). I’ve never had any problems whatsoever and my concerns have been acknowledged and responded to appropriately…
I’m so glad to hear that first part (I was hoping not to offend you)! And I had a strong hunch you’d be the kind and helpful type, no matter the situation, in return.
What an honor to get to help a friend at such a special time in their life! I’ve gotten to be around for some exciting times in people’s lives, and I really treasure them. We will be sending good thoughts your way!
When I went for a colonoscopy I noticed that the nurse was about to hook me up to a 5% dextrose bag, so I asked her what was her plan for administering insulin to cover that sugar. The supervising nurse got wide eyes and said “He told us he’s type 1.” They gave me unsugared saline instead…
Again I am not surprised…
I’ll update tomorrow when I’m done. I keep missing calls from the nurse and anesthesiologist but they said they could just talk to me tomorrow.
They want me to take 1000mg tylenol 2h before, but I have a message in to see if its actually important because I want my dex to work.
My insulin resistance has gone up with all the hormones and that I haven’t been allowed to exercise for the last week with these gigantic bloated ovaries (I had to make an emergency run for bigger pants) so I’ll just do my normal basal tonight and run slightly high. I did tell the doc today and made absolutely sure to get a note in my file that says “NO DEXTROSE IN THE IV!!!”
Time to eat! I had to rage bolus a 200 with 5u an hour ago and now I’m 120 with a double down arrow and have some FUDGE that I can’t wait to eat!
I really hope it goes well for you tomorrow and that the procedure is an overall success. Wishing you all the best Carolyn. 