Hip replacement - T1D challenges (long😐)

[Jan]

You are not allowed to bring any of your meds to the hospital. The pre-anesthesia meetings go over your meds in detail, doses and exactly when you take them.

I hadn’t been in my room long when lunch came. I was hungry! And feeling good, so the salad and hamburger with tomato and lettuce looked good. I sat there waiting for the nurse to bring my insulin, and finally had to hit the call button. In came Claire, wanting to know if I was finished with lunch. I said I was waiting for insulin. She lifted the cloche over the plate and said, “But you haven’t eaten yet?”

First of the protocols: no insulin until after eating. I explained to her that I needed at least 15 to 20 min head-start with the insulin, and it depended on what my BG was at the time. She looked at me like I was from Mars. Then we got into the next protocol: same sliding scale for everyone at every meal. No insulin:carb ratio, no correction factors, no target BG. Oh, and they use “carb choices” not grams. Which of course she didn’t know how many grams they equal to. She looked at her computer to see the appropriate insulin dose and said she would give me 10u. I did a quick carb count, used my Dexcom reading, and said I would dose 4u. She said no, it’s 10. I said if you give me 10u, it’s going to end badly! She went to get the Hospitalist.

The Hospitalist turned out to be reasonable, and said they would make a “custom” sliding scale for me. The problem was that each insulin calculation and injection had to be signed off by an additional nurse. So every time, Claire had to try to explain it to another nurse. I think the nurses must have been pretty frustrated with me.

I asked for a carb count in grams on each meal, and ended up checking her dose with what I would have done. It all worked out ok, except I had high BG the whole time I was there. I went home the afternoon of the day after surgery, and stayed very insulin resistant until today, day 4 after surgery.

The bottom line was the hospital staff were pretty accommodating as long as you advocated for yourself.
I have a PA at the hospital’s diabetes clinic, so I had some credibility. Please bring a detailed list of your meds and all your diabetes practices, in fact make several copies so you can share them with whoever needs to know.

Oh, and check every IV bag they hang…my IV antibiotic dose came in dextrose. My husband caught that one…

[bkh]

@Jan

Oh, and check every IV bag they hang…my IV antibiotic dose came in dextrose.

That’s a very important tip. They do tend to get that wrong from time to time, and try to give dextrose rather than saline.

[Jan]

I’ve been very insulin resistant since coming home from the hospital. The 1st day home I could barely get my BG below 250 despite major corrections.

I’ve had to increase my Lantus (from 7 to 10 u), and make my I:C ratios (from 1:10 to 1:6) and my correction factor (from 1:30 to 1:20) more aggressive. Today (day 7 post-op) is the first day my fasting BG was below 150. Hopefully things are turning around. I had no idea that the insulin resistance would last this long.

[Jan]

I’ve also been getting up at midnight to 3am and taking corrections !

[TomH]

@Jan Great follow-up and detail for others to watch for and discuss prior to surgery! Thanks. I particularly like that your hubby caught the dextrose IV!! I know a couple of folks that have a T1 info sheet they provide to doctors/hospitals on their insulin/meds regimen, put on a T1 wrist band right next to the one the hospital puts on, and “negotiate/advocate” right from the start. I’m always surprised that hospitals, the bastions of US medical practice, are so far behind the times: i.e. singular insulin scales for all T1s, eat first/insulin after… I appreciate hospitals have a lot to “keep up with”, but you’d think at least a bi-annual protocol review would be reasonable and necessary using on-board staff or as part of maintaining hospital privileges. It’s not like T1 is an orphan disease or a rarity they don’t encounter very often.

[TomH]

@Jan How you doing with recovery? Hope there isn’t much after surgery pain/impactl and you’re progressing. Do you know when/what kind of PT you’ll be doing? Has your insulin resistance eased or returned to normal as yet?

I’m scheduling my own surgery, looks like it will be mid Oct. My Endo’s weighed in on rec basal and continued use of Loop for best control, hopefully the team will be accommodating on watching the BG via my phone (I use Loop-dev). It’s supposed to be outpatient surgery, so I shouldn’t have to face the hospital nursing staff ref meals/insulin like you did.

[Jan]

@TomH

I haven’t had much pain, even from the beginning. I’ve only taken 200 mg Celebrex once daily and Tylenol. I’m down now to Tylenol once daily too. The main pain is the “bruised” feeling from the surgery, and my non-surgical hip due to 50% weight bearing restrictions on my surgical hip.

I’m using a walker for the weight bearing restrictions, I have to put all my weight on my non-surgical leg along with my upper body when walking, so lots of upper body soreness. This is due to the state of my bones once they got in there, more fragile with lower blood supply due to rheumatoid arthritis, and the necessity of putting less stress on them and allowing more time to heal well.

They don’t prescribe any formal PT for hips, just walking. I worked with PT in the hospital and have a handful of exercises, mostly heel pumps for preventing DVT, and a couple for the thigh muscles. Other than that, just “walker-ing”.

I’m still having some problems with insulin resistance, mostly over night. It has eased some, but not returned to normal. And I’m still using more aggressive dosing. I don’t know how long this will last.

I went to bed last night in the 90’s, woke up at midnight in the 150’s, and before I could get back to sleep had shot up to 175 with an up arrow! Had to take a middle of the night correction. It’s really weird how any time I wake up in the night, my BG shoots up.

Your endo team sounds like they are on top of things and hopefully that transfers to the hospital staff. Outpatient should give you fewer problems. Good luck! I’ll be praying for a successful surgery and speedy recovery for you!