After 3 months of various testing and laparoscopic biopsies, I’ve been diagnosed with advanced ovarian cancer and will be having a complete hysterectomy and also having my omentum removed. For those of you who have no idea what an omentum is (neither did I before 3 months ago) it’s a layer of fatty and peritoneal tissue that covers and protects all your abdominal organs. You can live without one, thankfully, but because the cancer first showed up in the omentum, it needs to be removed, which means that the surgery cannot be laparascopic. It’s going to be open abdominal surgery.
So, here’s my question: I’m going to have a LOT of scar tissue in my entire abdominal area, which is where I usually put my pump sites. I know I can use my upper thighs for sites, but do any of you use other sites I haven’t thought of? Can no longer twist far enough due to back problems to enable me to use the upper butt area. I use the back of my arms for my CGM, but I can’t think of how to use the same areas for sites while not ruining them for using the CGM. Any thoughts?
Sorry to hear about the diagnosis. You could take a pump break and try MDI while you’re healing - the beauty of it is, you can inject all over your arms, legs, and torso with one hand (no twisting needed). I only ever put my pump sites in my abdomen, but back on MDI I’ve been happy to be able to rotate more.
Thanks for the info. When I used to do MDI, I used the fronts of my thighs, but not really the side. So if I can use the side, that’ll give me twice as many sites.
And, yeah, I’m sorry I need to go through this, especially surgery. But I beat 3rd stage cancer of a different kind 25 years ago and, heck, I do not need 25 years more this time. I’ll be thrilled if I get another good five years. Thanks for your thoughts, Luis.
Thanks, Allison, but the last thing I want to do is go back on MDI. I really didn’t have great control then, and I love the control I get with the pump and CGM, with A1c’s consistently around 6.1. On MDI I rarely got below 6.5, which wasn’t bad, but I was also frequently closer to 7.0 or above. I’ve already got some kidney issues, and definitely don’t want anything that would worsen the situtation. But I do think Luis’ advice will give me enough sites for good rotation, which as you pointed out, is a key issue.
@Ruth As with others, I’m sorry you’re dealing with this too, but seems you have a good attitude toward it (though I’m sure there are times…). As to your question, it sounds like you’re using pods vice tubed pump. I use pods as well and have used the thigh (front and slightly inside) as well as the inside of arms (spaced roughly inbetween the bicep and tricep area. Both have the benefits of some protection (depends on your activity level), relatively easy reach, and seemingly protection from compression (depends on your regular sleep position). I tend to follow a pattern of pod round side up then round side down, so each site doesn’t get used but about every 12 or 24 days (can be stretched a bit by using the grace period depending on your how you approach/use grace periods. BTW, if you haven’t done so already, please ensure your surgeon(s), anesthetist, nurses, and hospital know of your T1/T2 status, insulin dependency, pump and CGM use, and share/get approval of your plan of how/if they’ll be allowed/used while in the hospital! You may want to look up Joanne Milo’s (just search her name, should come up with LnL, TD100, and her personal websites) recommendations on how to approach a hospital stay/surgery, she has definite ideas and downloadable recommended formats you can modify so they’re right for you and submission to all involved. Hope this is helpful and wish you the best with your surgery! Also beaware, some surgeons use “standard” post surgery guidance to hospital nurses, if you’re on a pump/CGM, you may need to ensure these are modified to fit your needs!
With Quickset infusion sets I would also use my sides and as far around to my back as I could reach. The Quicksets were flat enough that lying on them didn’t cause any issues or discomfort.
Wishing you luck with the surgery and recovery. You could try using the “love handle” area (sides of the hips) if you can reach it more easily than upper butt. I just do my best to make sure I place the site fully above or below where my pants waistband will sit, for comfort.
Thanks to you all. TomH, one of the major concerns I have is that I will be hospitalized for up to seven days. Two weeks ago I had laparoscopic surgery for biopsies, and the anesthesiologist was adamant that I couldn’t keep the pump on. Then I ended up back in the hospital due to what we’re calling and “anesthesia hangover” (dizziness, confusion), and again they wouldn’t let my pump do its job. I’ll look up Joanne Milo to see what she has to recommend. I think my doctor may be setting up a meeting with the anesthesiologist to discuss this.
For bkh and Rachel, yeah, I think I can get maybe two sites on the right upper edge of my butt/love handle area. Definitely can’t do the left side, as I won’t be able to reach across and I’m a righty, so putting a site in with my left hand isn’t an option. With all your advice, I’m pretty sure I can get enough sites to be able to rotate so that I don’t ruin any one site.
Thanks for all your good thoughts, Can’t wait to get this over with!
Ruth, I am so sorry you are facing all of this. That is such a huge amount to process on top of managing diabetes too. I have seen people mention using outer thighs, lower back areas they can still reach, and sometimes even upper hips for pump sites after abdominal surgeries, but I really hope others with firsthand experience can chime in with what worked best for them long term. Wishing you strength for the surgery and recovery ahead.
@Ruth I can appreciate the anesthtist’s concern about using a device he isn’t familiar with. However, after you leave the operating and recovery rooms, the doctor and hospital’s policies take over. Given your previous history (dizziness), using your own device may not be the best choice as you don’t want to be “in control” if you’re not capable of being so. The next best thing may be having a CGM monitored by the nursing staff, or a loved one or friend with access, alarms, and the hospital on speed dial. Either way you and they need to be aware of what controls exist/will be used and who is responsible for monitoring your BG in addition to the primary purpose of your being there. Post surgery patients are often given IVs with dextrose or some other sugar to provide fluid and a source of energy for your body to use; while it prevents hypoglycemia in the majority of people, it also introduces the possibility of hyperglycemia for us T1/T2s. This can quickly drive you into DKA territory, a complication nobody wants. If the nurses aren’t vey watchful of CGM reports or doing finger sticks regularly, DKA is a real possibility you and they don’t need…there’s enough on already. I’m sure you’ll get the situation addressed appropriately and wish you the best of outcomes!
@jesusamay Thanks for the good thoughts! I beat third stage cancer of another kind 25 years ago, so I’m hoping to do it again. And at the age of 79, soon to be 80, I don’t need another 25 years. At the rate I’m losing height in my spine, I’d probably be about three feet tall by then!
@TomH One of the things I am very lucky about, or at least I used to be and I think it’s still true, is that I never produce ketones, no matter how high my bg goes. Back when I had chemo 25 years ago, my bg was so high that the chemo lab took blood and waited for the results of the bg and ketone testing before they would infuse me. My blood sugar was 1,003…and no, NO ketones! No wonder I have a hard time losing weight. But at least I don;'t have to worry about DKA. The only thing I do worry about is the fact that hospitals tend to let blood glucose run quite high, rather than risking lows, and as we all know high bg’s can make us more prone to infection. I’ll be in the hospital for at least 3 days and possibly up to seven, and it’d really be nice if we can keep it to below 190. If I don’t have confusion after the anesthesia and can manage my pump by day 2, I’ll feel a lot better about it.
I am way more scared than my friends know, but I also have quite a bit of optimism, Just can’t wait to get through to the other side of surgery. The continuing treatment, i,e, chemo, really doesn’t scare me. It’s not pleasant, but it’s not life-threatening either. A 4-8 hour surgery, however, scares the daylights out of me.
A comment on “BTW, if you haven’t done so already, please ensure your surgeon(s), anesthetist, nurses, and hospital know of your T1/T2 status, insulin dependency, pump and CGM use, and share/get approval of your plan of how/if they’ll be allowed/used while in the hospital!”
Several years ago I had a slight stroke and immediately went to the Emergency Dept of a good hospital. They used a clot-busting drug that worked well and all effects of the stroke disappeared, but they thought it I should go on a blood thinner and wanted to check me into the hospital to monitor as they figured out the dose. I was briefly interviewed by the adminissions doctor, who then wrote up the order.
i soon discovered they would not allow me to manage my BG levels, and they clearly did not know how to do it themselves for T1Ds, since they mostly saw T2Ds. They gave me food with way too much carbo and failed to give me sufficient fast-acting insulin, and were not concerned my BG level stayed in the 200+ range all the time.
My mistake was not to have gotten an agreement before admission that I would manage my BG levels. A couple of years later, I had a procedure that required brief hospitalization, but this time, I got a letter from my Endo doctor asking that I manage my own BG levels. By this time, the hospital had a procedure where I could sign a form taking responsibility for BG problems (so I would not later sue them), which I gladly did. All went well, no problems while there.
@jim10, I hear you, Jim. Back in 2018, when I was still living in Massachusetts and my PCP was also an endo, I had both knees replaced. Each time my PCP went into the hospital as soon as I was assigned a room and wrote in my chart that I was to test my own bgs and manage my own insulin. It was great! The nurses were astounded, and kept coming into my room to ask questions about the pump.
Now I’m living in Connecticut, all my doctors are relatively new to me, and the anesthesiologists, two so far, are adamant that I cannot manage my own bgs/insulin. As it happens, I had a real bad reaction to anesthesia when I had the biopsies, and I couldn’t figure it out anyway. I had turned the delivery off in the OR, but I wasn’t able to turn it back on. That may happen again, which is what scares me the most about surgery. But I will have the pump attached, and I’ll be in the hospital for at least 3 days and possibly 7, so if my brain is working, I’ll turn the pump back on as soon as I’m able, whether they like it or not. I’m also going in with a Libre 3, so my CGM will last two weeks. My friend who is my health care proxy is going to learn how to turn the pump off and on this weekend. Plus, I’ll have her bring my supplies in so if I run out of insulin, I’ll be able to change my site.
In hospital, the issue isn’t really if you’re T1 or T2. The issue is whether or not you’re insulin dependent, and I’ve yet to meet hospital staff who have the slightest clue of how to handle someone on an insulin pump. Really should be required training, don’t you think?
@jim10 Great idea on the Endo coming in a signing as you indicated. I didn’t do that and will definitely consider it when/if I’m admitted again. @Ruth I’m glad to know your friend is there and will learn how to turn on/off the pump and provide supplies if needed…great idea! Makes me think more about ensuring my wife/daughter are more familiar with what I do and how I do it with my DIY AID system and timings of pump and CGM replacements and how to tell how long they have until mandatory replacement. I’ve had my wife apply a pump and activate a CGM, but its been awhile. We’re probably giving some good ideas to @ClaudnDaye and Liam for some podcasts!
First of all, I’m really sorry you’re dealing with all of this. I have seen some people mention using areas like the upper outer thighs, lower back or hip area, and sometimes the sides of the arms when the abdomen is not ideal. It may take some trial and error, and it might also help to get guidance from your diabetes team on site rotation during recovery. Wishing you a smooth surgery and recovery.
You could try using the “love handle” area (sides of the hips) if you can reach it more easily than upper butt. I just do my best to make sure I place the site fully above or below where my pants waistband will sit, for comfort.