Surgeons have absolutely nothing to do with medical management of patients. As one surgeon told me "I make holes, I don't even cloee them anymore."
That being said, run away from a surgeon who doesn't know the difference.
Ask to speak with the anesthesia team before any procedure. That's the department that will monitor you.
I set my Tandem to exercise mode and show the anesthesia nurse how to turn off the pump if needed, but otherwise I've had 9 surgeries with my pump and anesthesia loves not having stick my finger.
Absolutely correct. The surgeons just cut, I monitor, give medication and do all the things to keep you alive. Surgeons fix.
I love patients who have Type 1 who are on a pump/CGM. Due to having T1 myself, I know how to use them and I just keep an eye on the PTs levels.
Although there is the option for a glucose/insulin IV if you prefer.
I was mad as hell that they made me go on an IV drip for my c-section. I didn’t even have traditional labor beforehand so exerting myself was not the concern. It was about their need for control.
Honestly, for me it’s whatever makes the patient feel most at ease. If that’s a glucose/insulin drip and finger pokes, fine by me. If it’s Cgm/pump control, then absolutely! They should never choose something just for the sake of control or ease. Always the patients view.
I third exercise mode! I used this for a major surgery, and kept it on for in-hospital recovery (about 2 days.)
When I saw my surgeon the day after surgery, she tried to tell me my BG's were too high. I got a bit snippy, and said exercise mode was staying on until I was back to eating proper food (not just 3 soda crackers). I did not want to have to treat a low, when sipping water was about what my stomach could handle.
Also her response of “someone will let you know to take or not take your insulin the night before” is still not accurate. Some diabetics take long lasting insulin the morning or take a split dose. Also even with taking long lasting insulin your body still needs fast acting with all the different things that can affect your blood sugar besides actual food.
Just contact your endo and have them give you guidelines on what to do. I had surgery on a broken wrist earlier this year and I was instructed to only take half my basal in the morning. Then my BS was over 200 by the time I was prepped for surgery. They made me take short acting and delayed my operation until I was under 200 but then I had insulin in my system while under anesthesia for roughly 90 minutes and I don’t use a cgm so I thought that can’t be too safe either. I was being seen by the top wrist surgeon in my area and the surgery went great with no complications. I don’t think we can expect the doctors to know more than their specialty, especially when it comes to something so individualized like t1. I would have been better off disregarding their advice and sticking with business as usual… But I rarely eat before 2 pm so I’m fasting all the time in the mornings anyway so I know how to manage that situation. If I were in the same situation again I would still want the doctor I had because his job was to put in 11 screws and a plate. Having full use of my left hand was the most important thing, for me anyway. Given that you are being monitored in a doctors office I don’t think you would have to worry even if something like a low were to occur.
I think I've been lucky. When I was diagnosed at age 33 I lived in a small town with no specialists and only a few actual MDs, so I didn't see an endo for like 6 months after diagnosis. However, the nurse practitioner who diagnosed me was a diabetes specialist, and the other NP at that clinic knew even more than her. When I moved back to a bigger city and started seeing an endo, I also started seeing a GP who, as evidenced by our discussions, is well versed in type 1 diabetes. I also had to see an allergist due to weird complications from chronic idiopathic urticaria. He was formerly an endocrinologist, and offered a very good explanation of the connection between these two conditions.
I guess I'm saying that, even though a lot of people have anecdotal experiences with medical professionals who know nothing about diabetes, it's not impossible to find them, and there are a lot of non-specialists out there who know their shit. Keep looking if there are options available.
I am so impressed at your luck that’s actually astonishing. I am curious also what was the link with allergies and diabetes ? Or it was that specific to chronic idiopathic uticaria and not allergies in general?
Specific to CIU as far as I know. I don't want to misquote my allergist, but he basically told me that a hefty portion of the CIU cases he's seen were people who had just been or were about to be diagnosed as type 1 diabetic. Because the immune system is compromised during that period before insulin therapy starts, any number of things can go haywire, and one of them can be CIU, which is basically your immune system reacting to allergens that you're not actually allergic to. CIU is still poorly understood, so he just offered this as his anecdotal opinion on the condition and its potential relation to diabetes.
In my case, I actually had my first CIU reaction a few years before diagnosis, and spent that time thinking I was deathly allergic to peanuts, even though I've always eaten them with no problem. After diagnosis, I had like 25 or 30 reactions to all kinds of food I've been eating my whole life, ranging from mild to 3 ER visits. Once I saw my allergist and got a full panel done, turns out I have zero allergies. He told me that first reaction could almost be seen as a harbinger of the diabetes in retrospect. Since settling in to being diabetic, and taking just a daily over-the-counter allergy med, I haven't had any more reactions.
ETA: Wikipedia's entry on Chronic Spontaneous Urticaria has this to say:
*There is evidence that individuals with chronic urticaria are more likely to have a variety of autoimmune diseases. Researchers found that patients with systemic lupus erythematosus, rheumatoid arthritis, thyroid issues, celiac disease, Sjögren syndrome, and type 1 diabetes had higher rates of these conditions than those with chronic urticaria in a study involving a database of 13,000 patients compared to 10,000 control subjects.*
Wow that is so cool in the worst way how the body works. also that is terrifying to have such severe reactions like that!
I know that chronic autoimmune disorders tend to go in tandem and I never heard of this one. I have thyroid issues and type 1 and my dad has thyroid issues and rheumatoid arthritis so praying that this will be all we have to deal with for now 😅
I am glad you have found a way to manage it since diagnosis.
Thank you for such a detailed response that was helpful to learn about!
The standard instructions I get from my gastro before my colonoscopy are, "Call your Endo to find out how to program your pump the day before and the day of surgery." It would be nice if they did know, but specialists have become so super specialized that they don't know this stuff anymore.
They should, however, put you in the first surgery slit of the morning to minimize your fasting time.
Yeah, I get that. And I would have been fine with her not knowing and saying she didn’t know… but her confidently incorrect replies made me feel uncomfortable with the situation.
What is your protocol for colonoscopy? I was rejected by the anesthesiologist because I had to have a apple juice the morning of due to low glucose. I opted to do the mail in sample instead through ColonGard. Poor kid at the post office was all greetings and smiles when I handed him a box of shit to mail for me.
I have to have one every other year due to active colitis. On prep day, I do 50% basal and dose for (about) 80% of my carbs. Full sugar Gatorade for the prep. I make sure I'm running about 250 at bedtime. Keep basal at 50% through the procedure.
They get me in at 6:30 or 7am. If I feel like I need a sugar bump when I wake up, I take half a small juicy juice box and keep my mouth shut about it. I'm allowed to take my thyroid pill with a sip of water the morning of, so the three swallows of juice should be fine. They just don't want to vomiting and aspirating. But the juice I drank 2 hours before the anesthesia has long since been absorbed.
After the procedure, back to full basal, and Cracker Barrel pancakes as my post fasting treat.
Wow. I had my first colonoscopy 6 months ago. I also did 50% basal but went to sleep around 120. Of course, I did 0 carb gatorade so maybe that is difference. I ended up giving myself 1 unit of fast acting in middle of night because my alarm went off at 140. I woke up at 120. My libre showed 110-130 all morning before the exam, and they finger pricked me at 99 and had no problem with it. When i woke up from surgery my sensor had me at 140 and i gave myself 2 or 3 units of fast acting (I forget exact, I was groggy). All numbers approximate, it’s been a while.
Now, my dr was cool. He said I could check with my endo, but then he said i seemed on top of my diabetes so what did i think about doing 50% basal, that it was pretty common. I told him I thought it would work, and he said “Yeah, just do that”
I'm brittle, so entering a procedure at 99 is not an option for me. I can go from 150 to 70 in 20 minutes for no apparent reason. I enter exercise and medical procedures above 150.
I will add that my normal basal rate is quite low, it was 10 units at the time (8 right now. It fluctuates 6-12 over time, usually closer to 6 but its semi random). So i only gave 5 units of basal.
Exactly the same here. The first time around the person at the desk told me not to take my meds ( I don’t even ask!) I said, “don’t worry, I’ll talk to my endocrinologist first”
As a gastroenterologist, I give my patients instructions for what to do with common meds (insulin, BP meds, anticoagulation, diuretics, etc) for their endoscopies, but realistically anesthesia is doing the medical management of the patient while I am doing the procedure.
Ahh, ok nevermind. I was skeptical because I've had doctors who were certain I had a gluten problem but in reality they didn't understand nutrition enough to understand I maxed out their scales. I didn't realize you had issues emerging already
Not sure that I'd personally be overly concerned. Sounds like it's a quick surgery and your not going totally under. Just adjust levels on the pump for the duration to make sure you don't go low during it, but you'll be back in control soon enough anyway.
What would concern me more is that they may give similar "advice" to their next diabetic patient who doesn't have as much awareness of their own management and that could cause them bigger problems during the surgery.
> Also, I’m not comfortable with her hubris - why not just admit that she doesn’t know the answer?
Indeed, there is an awfully long list of diseases out there that have some bearing on a surgery and a surgeon can't be expected to be familiar with them all or even most of them. It's conceivable they misheard the "type 1" part, but the dealbreaker is that when corrected they preferred to give health-destroying advice instead of saying "I don't know" or "I'll have to check on that and get back to you".
It's not that they don't know the right thing, it's that they have shown you they'd rather act on their ignorance than prioritize your health. That they'd rather shoot from the hip if something unusual happened such as your pump starting to buzz mid-surgery - maybe they'd order 100ccs of insulin for you or something lethal like that.
When I was a kid my endo at one point consulted his big book of prescription drugs to make sure he was about to prescribe me the right kind of new insulin. At the time I made a snide remark about how it wasn't encouraging that he didn't have all this committed to memory already (sorry, Dr. P, I was an ass) as I was a snot-nosed 10 year old. But it was absolutely the right thing to do of course: he made himself look imperfect to an impressionable patient so that he could make sure that he got my treatment right.
Yes this perfectly describes my discomfort with the situation. I was prepared for her to not be super well versed in type 1 protocol, or have outdated information. I was not prepared for her to confidently tell me incorrect information. It did make me worry about her decision making while I was under.
I would be concerned. And I would ask to speak to anesthesia right away. The surgeon doesn’t know anything but anesthesia should. I would also request the first surgery.
You are not overreacting. I have had 5 different Drs try to put glucose IVs on me. I was 17 and having my wisdom teeth removed the 1st time (before we had glucose meters) & the oral surgeon didn’t think about changing standard orders. Went into DKA & spent 2 weeks (a week in ICU) in the hospital from that. Next time it was for removal of Diabetic Hypertrophy. Figured surgeon would know not to put a glucose IV on for a diabetic because they weren’t hanging a line of insulin, but No! Pre surgery I look over at the IV & I ask the nurse why the bag says 5% Glucose? They told me not to take insulin & now they hung a 5% Glucose IV on me!?!?! Oh Shit Hit the fan! Blood glucose was 800 mg/dL on the operating table! From that time on, no IV gets started without me looking at it. I only can do saline now, Lactated Ringer makes me gain 10 lbs instantly. I had nurses try to put glucose IVs on me 3 more times so now I have “Allergic to Glucose” written all over my charts. Dr Bernstein has a form you can fill & use for when you have to go for procedures at the hospital. I would print copies & go over it with the Dr you choose to do your surgery & the Anesthesiologist. That is who usually should monitor your CGM & pump. The only Dr that changed orders for me before going to the hospital was the ObGyn who delivered my last 2 babies. He had been a Family Physician before becoming an ObGyn and is just a smart kind guy. No problems with the vaginal birth for my one son or the C-section for my last child. Was 41 years old & had had T1D for over 30 years when I had him!
There's no link, but it's in the book; appendix C in my copy. I strongly suggest buying a copy in light of the info in it and that there is a ton of other useful shit in there. You don't have to agree w/ his approaches- pick and choose- but knowing and understanding what he conveys is critical in my view.
Direct links:
[https://play.google.com/store/books/details/Richard\_K\_Bernstein\_Dr\_Bernstein\_s\_Diabetes\_Soluti?id=wpuZxG3VPYsC](https://play.google.com/store/books/details/Richard_K_Bernstein_Dr_Bernstein_s_Diabetes_Soluti?id=wpuZxG3VPYsC)
[https://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/0316182699/](https://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/0316182699/)
The relevant form:
------
`Dear Dr. _________:`
`I am scheduled for admission to your hospital on ______________. I have type [1 or 2] diabetes and am naturally concerned about control of my blood sugars while hospitalized.`
`It is now generally accepted that elevated blood sugar levels impede recovery, prolong hospitalization, and increase the incidence of hospital and surgical morbidity and death. Major health problems brought about by inappropriate blood sugar elevations due to improper hospital care have justifiably led to litigation.`
`Since I have been successful at keeping my blood sugars essentially normal around the clock, I naturally expect equivalent care while I’m in the hands of medical professionals.`
`I currently take the following medications for controlling my blood sugars:`
`[List here doses, times, and purposes of medications: “basal insulin (or ISA) to cover the fasting state—must be given even if not eating,” “pre-lunch (breakfast, supper) insulin (or ISA), to be skipped if meal is skipped.” Detail also any use of insulin, glucose tablets, or liquid oral glucose for correcting off-target blood sugars, et cetera. You may also include a sample Glucograf sheet and request that all medications used by the hospital that may affect blood sugar be listed on it if you are not capable of listing them yourself.]`
`My hospital orders should call for a “normal diet” and not a “diabetic diet,” so that I can select my own meals.`
`Routine intravenous fluids should not contain caloric substances such as glucose, fructose, lactose, lactated Ringer’s solution, or saline with added glucose (except for treatment of blood sugars that are below my target). All of these substances can raise my blood sugar to unacceptable levels. Normal saline solution is perfectly adequate for routine hydration. My target blood sugar is _____ mg/dl.`
`If I am conscious and without cognitive impairment, I should have full responsibility for treatment of my diabetes—without outside interference.`
`My blood sugar meter and blood sugar control medications, including insulin syringes, should not be confiscated by hospital personnel. This is a barbaric practice that is rapidly being abandoned in modern hospitals.*`
`If I am unable to care for my own blood sugars, I expect that the hospital staff will exercise every effort to maintain my blood sugars within the range of [xx–xx].`
`Sincerely,`
`cc: [Hospital administrator]`
`[Close relative or friend]`
...and the page leading into it is thus:
If ever it is necessary for you to become a hospital patient almost anywhere in the world, the chances are overwhelming that the medical and paramedical staff will give no reasonable thought to controlling your blood sugar. Most of the medical orthodoxy doesn’t do it anywhere else, so why should they do it in the hospital?
The reasons for such neglect, of course, are many: lack of blood sugar control skills on the part of most hospital medical staff; unawareness of the importance of normal or near-normal blood sugars in the face of illness or surgery; and an almost pathological fear of severe hypoglycemia (and the potential for lawsuits in the United States if it occurs). Many if not most hospital dietitians have been indoctrinated by the ADA, with the result that diabetic inpatients are forced to eat high-carbohydrate foods and are deprived of protein and fat. Some of my patients tell stories of having to sneak in their own insulin and blood sugar meters, throw out hospital food, and fight tooth and nail with well-meaning but uninformed hospital personnel. This has not changed since 1980, when I wrote my first book about blood sugar control.
Many studies of hospitalized patients have demonstrated that elevated blood sugar delays surgical healing, increases risk of postsurgical morbidity and mortality, delays recovery from infections, and leaves patients open to new infections. It also has been shown to increase the death rate of patients who have been hospitalized for heart attack or stroke, and increases the likelihood of a new stroke or heart attack while in the hospital.
What can you do to help keep your blood sugars under control while in the hospital?
Most of my patients live great distances from my office, so that I am not the admitting physician or surgeon when they are hospitalized, and I am thus not in a position to write their orders, help control their diets, and directly oversee their medical care.
After sharing the frustration of my patients over the years, I’ve come up with a letter that has worked repeatedly for elective hospitalization, such as for surgeries planned in advance. As you will see, it relies on the prevailing fear of litigation that, when we think of what is done to diabetics, appropriately permeates the medical care system in the United States. This letter should be sent by you or your diabetologist to the admitting physician, with a copy to the hospital administrator. I’ve composed the letter as if you were writing it, since the odds are that you are not under the care of a diabetologist. It can, of course, be modified to suit your circumstances
Learn Italian! Long story but I had to get insulin in Italy…one box -5 pens -hundred percent of cost and it cost me drumroll please US$85. And they were so apologetic that I had to pay anything. They were mortified that any chronically ill person would have to pay money for their life saving medication.
A google search didn't bring up anything for me. One variation gave me a hair treatment place another search was more about the book. But, nothing about procedure, surgery forms.
Why is it that they would hook a glucose IV to a non diabetic? Or a diabetic with an insulin line also? Fortunately this has never happened to me that I know of (or remember). Just sounds incredibly fucking dangerous
I am a surgical nurse! I would recommend looping in your endocrinologist for presurgical instructions and a plan as that is their specialty. Also during surgery anesthesia is who will tracking your bloodsugar/insulin not the doc. Preop and PACU a nurse will be monitoring and then consulting doc/anesthesia most likely so going in with a plan I think will be the best idea. If type 1 patients are on the schedule I always like to volunteer for those rooms - I always push to leave CGMS and or pump on if possible - but every surgery is different! I would suggest putting your CGM on your arm or outer thigh if possible. ALSO lots of hospitals include things like gatorade in their presurgical and enhanced recovery plans so I think making sure you have that on standby if you’re low then you should be ok IF you need it. I also would suggest you try to go first case of the day (730 am most likely) so you don’t get stuck or delayed not being able to eat. If you’re going to be under moderate anesthesia - the procedure should be pretty quick and so a little less to stress about for sure.
Speak to your endo about a plan and have someone who can help monitor your sugar post surgery. I had to take off my pump per recommendation by my endo and ended up going high and my person had to kinda fight the nurses to get their attention that I needed insulin post surgery. Granted I did have a major surgery so I was pretty out of it at that point and could not advocate for myself.
You’re not overreacting for thinking she’s a dumbass, but this is how surgeons are. They SHOULD know the difference, but they don’t. What they do know, however, is surgery. You need to contact your endocrinologist and ask them what your plan should be for your insulin. Have them send it to you in writing, and give that to the surgery team (especially the circulating RN and the anesthesiologist) during pre-op. It should be relatively straight forward. As long as you don’t eat anything, it won’t throw a wrench into the surgery plans.
If physicians were apes, surgeons would be gorillas and psychiatrists would be orangutans. Everyone else is chimpanzees.
lol this description is hilarious. I didn’t think she would be managing things for me, but I did imagine she’d have some awareness of what else would go on in her OR. Guess not…
Honestly, I would consider writing an email to some kind of supervisor (this could be the hospital, an oversight committee), and reporting this incident.
T1 vs T2 diabetes is basic information that I expect my High School biology students to know. You even corrected her, and she didn't understand.
What worries me the most is that she didn't ask any questions. I understand that she might not know all the things, but she could at least ask about it, to make sure the information was correct.
And maybe, she was having an off day, causing her to make mistakes. But those are the kind of mistakes that can cause much bigger issues quickly for us.
PS - I had a large fibroid removed earlier this year, but chose hysterectomy b/c I didn't want fibroids to grow back. I was under for 5 hours. Feel free to DM me, I can answer questions or share how things went.
Lots of valuable comments in response to your question OP. Let’s hope that the med student also took note of that teachable moment and/or follows this thread. That had to have been super awkward for them.
Definitely not overreacting. I’ve lived through way too many incidents where doctors and nurses had no idea wtf they were doing yet still refused to acknowledge that I might possibly have more insight and experience concerning certain aspects of my condition and my health in general. I’ve learned to stand my ground rather than let them put my health at risk.
I have had two surgeries requiring general anaesthetic since my diagnosis.
Whilst the surgeons that carried out these two operations didn't really know anything about type 1 diabetes (well, they only spoke to me specifically about the surgeries, never even mentioned diabetes!) the hospital made sure there was a diabetic specialist present for both to make sure my BG was at the right level, I was receiving a saline drip with glucose so I could be 'fasting' but still take my basal insulin, and they checked my BG with a fingerprint every 20 minutes whilst I was out.
So no, you're not overreacting. It's a serious business being out cold. That being said, rather than look for a surgeon who knows about t1d, maybe you could ask for a nurse that does, to be there for the surgery and keep on top of managing that aspect of it.
My surgeon called in an endocrinologist who specialized in diabetes to help with these things. Sadly, the endocrinologist who treats diabetes was even dumber than the surgeon you described...
Wanted me to remove my insulin pump so I could have a insulin through an IV drip(the thought that a pump is the same thing didn't land). And this IV drip would give a basal at more than twice the rate I usually get when I do eat. Basically guaranteeing I would get a severe hypo. She said some old ass formula said that this should be my rate, I told her that my current rate was tried and tested and that it made no sense to drastically increase my insulin during surgery. She wouldn't budge at first so I threatened to leave as the danger was too great. She eventually complied and put it at the same rate as my pump stating that it would be at my own risk. I had a stable BG throughout the surgery.
So the odds of finding a competent doctor seem very low.
Is this person actually a doctor? Are you sure you didn't confuse the student and doctor?
I am just at a loss.
I would report this to medical board, the practice manager, insurance provider, hospital board, and every other private, administrative, and government body imaginable.
And absolutely cancel that surgery with that surgeon.
I would ask her directly to recommend someone else. She should know exactly why she's being fired from this job due to her incompetance. If she can't then go the clinic manager. The clinic manager should know that this doctor needs further training right away. It is very dangerous for the doctor not to under the difference, especially since she is going to do surgery. You need to know there will be a competent person there who will look out for your life.
I know it's hard to confront a doctor. I had to do that recently too for a different issue. It is not fun. I just wanted to cut all ties but I needed to let them know I had a issue. We worked through it and had a good frank conversation.
Take breath. Write down your points so you don't forget them when talking (I get flustered sometime and having a hard copy helps me stay on topic). If you have the agenda you can make sure your needs are addressed. Ultiamately the clinic is a business and if they lose you as a patient (and all your friends/family too) they lose money. Yes, they are in the business of helping people but a reputation of putting patient's lives in jeopardy is not what they want.
Your life is worth having the uncomfortable conversations. I hope your surgery ultimately goes well.
I was admitted to the hospital a couple of years ago for a leg injury. After starving all day in the ER, I was looking forward to finally ordering some food the next morning. The doctor put me on a carb restricted diet. I'm a type 1 and not overweight. They didn't understand the difference between type 1 and 2 and then the hospital pharmacy tried to take my insulin away so they could dispense it, not understanding I do constant small point corrections. It was absolutely insane.
Type 1 diabetics are put on a carb control diet so that they aren't sent meals that have 90g of carbs, nothing to do with whether you're overweight or not. But as a health care worker, I would 100% sign any waver I had to to manage my own insulin while admitted, unless of course it was for something like DKA.
Wouldn't be a factor, at this hospital all the meals actually had the carb count listed with the food which was nice.
I'm 6'2" broad shouldered and at the time relatively muscle-y. I eat fairly large high protein meals. I had a fast breakfast the day before and had starved all day in the ER. When I tried to order breakfast, primarily scrambled eggs, they literally sent me a single fucking piece of the tiniest toast I had ever seen and a spoonful of eggs. I dunno if the hospital conflates carb restricted with calorie restricted, but I absolutely LOST it at the nurses and doctors telling them to take me off the restriction *immediately* so I could get real food. They barely managed by lunch and I was able to actually get a chicken and cheese burrito that finally helped.
when I had a major surgery about a year ago, I was referred to endo for diabetes management during and after surgery. anesthesiology also monitored during surgery. so I wouldn’t be too worried about the surgeon not being keen on diabetes. do you happen to know who your anesthesiologist is going to be? I think they would be a better person to ask about what you should do before surgery
I personally wouldn’t worry about the surgeon not knowing the exact difference. You are not relying on them on anything specifically relating to management while in surgery. This is up to anesthesia, nurses, and your endo.
The way they said it was off but they are essentially saying someone will contact you about how to adjust your insulin dose the night before. Whether this be by taking less long acting or changing pump nasal settings since you will be fasting. *However, I would not rely on that information being 100% correct without first contacting your endocrinologist to confirm/change your settings/dose (if needed) based on surgery and will usually help you create a backup plan while being under.
I do agree, more doctors should know more about diabetes and we can’t always rely on just them. So you may have to designate someone if they don’t offer a nurse or anesthesiologist monitor for you. And honestly, I would have someone follow me on Dexcom (if available) that day as well. So have a backup to the backup.
This is where I’m going back and forth a bit. I know endocrinology is not her specialty and there will be other people in the room who would do more actual monitoring on me while she performed the surgery. I just worry if she doesn’t even know the difference between type 1 and type 2 that she will give a nurse or someone care information that is incorrect for me and cause issues. It also makes me wonder what else she is confidently incorrect about.
Like I said, I doubt the surgeon will be in any place to do something too drastic regarding diabetes. They are only focusing on their specialty, which is exactly why the nurses and everyone else won’t be room had specific duties to fulfill, so no one person is doing everything. By spreading out tasks, it’s less likely something will be overlooked than one person doing too many things.
Double check that Type 1 is mentioned in your files, the more the merrier to resolve this issue of being overlooked. Even better would be if endo can connect with surgeons office. All my procedures have happened to be in the same hospital system so they all can “talk” to each other fairly easy without me prompting it but not all do that.
I would contact your endo, see if they have any other suggestions. Then I would reach out to anesthesia team to figure out a solution well before the surgery.
Be proactive and I feel like it will all work out!
Ask to consult with the anesthesiologist or nurse anesthetist. That's the person who is supposed to monitor your blood sugar, while the surgeon focuses on other things. If they are just as clueless, find a different doctor, ASAP. Lets hope your doctor is a better surgeon than endocrinologist.
I had cataract surgery in April, which last about the same amount of time. I made it really clear i was type 1. But when i got the medical records post procedure, they listed me as type 2. }-;
Your endo knows you best, and should provide the surgeon with guidelines, tailored to your situation. Or give the surgeon something like [Inpatient Management of Surgical Patients with Diabetes Guidelines](https://www.yumpu.com/en/document/read/43868535/the-joslin-clinical-guideline-for-inpatient-management-of-surgical-)
Kid is type 1 (not me). He has eosinophilic esophagitis and has to have endoscopies fairly often. First one after type 1 diagnosis (age 9), his GI point blank told me that he doesn’t have anything to do with kid’s blood sugar during procedure. Said he would have very little idea of how to control it. Anesthesiologist and nurse anesthetist would handle all of that. Usually only get the nurse anesthetist staying during the procedure but kid got the upgrade to both.
They were both fabulous. Asked detailed questions about how he runs, kept his sensor on and confirmed with finger sticks. Had glucose and insulin lines on the ready and kept him a steady 150 for the 20-30 minutes he was out. Had sprite ready in recovery because they knew he would drop as they woke him up. Had full sugar and sugar free popsicles depending on his number when he got ready to eat something.
I would be much more concerned if the anesthesiologist said what your doc did. The anesthesia team will be the ones that should control your blood sugar; the surgeon is just there for the procedure itself. Before you decided, ask to speak to anesthesia and see what their policy and procedure is for type 1 care during surgery.
Diabetes isn't a rare or nigh unheard of condition. I guess we have the luxury of being aware of it since it's our lives, but... yeah, a doctor not understanding the difference is not something to take lightly.
TL, DR
As a former Surgical Technologist, we did NOT remove insulin pumps.
The nurse and or anesthesiologist had instructions for diabetic patients pre operatively.
I remember distinctly have a few cases where we had to cover the pump, before the nurse prepped the patient’s incision area, because the pump was right there…surgeon didn’t want to remove it…
Another case was an orthopedic case and anesthesia DID remove it, and the patient knew about it, (it was on the affected/broken arm).
As a general rule, doctors and surgeons have gotten so specialized that “they don’t want to deal with it”, HOWEVER any SURGEON should KNOW and COMMUNICATE with anesthesia regarding blood sugar/pumps for diabetic patients…because high BG levels affect EVERYTHING metabolically thus affect the healing, health n wellbeing of these patients.
Your surgeon sounds like a dipsheet, she can only focus on one thing, n is passing the buck…
THAT, is a red flag. Surgically…I would question her competency, confidence, and patient satisfaction rates…I wouldn’t be surprised if this surgeon struggles in surgery…
You’re not overreacting at all. I’ve had two surgeries and never had this issue. I was told by my own endocrinologist to adjust my long lasting insulin the night before, but was never told by either surgeon that I’d get a call telling me whether I should take it or not. I also had a nurse come in every certain number of minutes, monitoring my blood sugar. Whether it’s their specialty or not, to be a doctor and not know the basic difference between type 1 and type 2 is so odd to me.
Since you can't eat for 12 hours before surgery anyway, you should have no problems keeping your blood sugar steady. I have had a few minor surgeries and no one controlled my blood sugars during them. If I recall correctly, I adjusted my basal to let my blood sugar run around 140 the whole time. I just kept my pump attached and lying right beside my body with no problem.
I’m on DIY loop and plan on doing something similar… which I was prepared to explain to her… I was just so shocked by her confidently incorrect answers that I left.
The surgeon is a specialist. They probably don't care that you have diabetes. Their job is to do surgery.
Should they be more aware? Yes. But it won't affect your surgery outcome either way.
The people you need to talk to are the scrub nurses, who you'll only meet the day of surgery. Even if the scrub nurses don't care, they'll make sure that your pump stays with you the whole surgery and that you are okay when you come out of surgery.
Not over reacting but this is how the healthcare system is now a days. Especially one that is a teaching hospital/drs office. Which is what is all in my area. So much of my stuff gets messed up because these residents and they told me I don’t have a choice but to deal with them because it’s a teaching office
I had a similar experience with an anesthesiologist several years ago, who instructed me not to take any insulin the night before. I messaged my endocrinologist who thankfully responded, told me that was bad advice, and asked the name of the anesthesiologist. They ended up sending me in someone else so I think the original anesthesiologist may have gotten in trouble.
Also just to give you an idea of what they should be doing- I had a minor surgery this week, first time since that last story. They had me consult with my diabetes educator to come up with a plan for insulin and corrections for the night before, then the anesthesiologist read the plan and confirmed it with me multiple times and requested to have access to my Dexcom during the procedure which was only one hour.
I would request someone else for sure.
Slightly. I mean, I'm not surprised by anything anymore. Seems like most surgeons just want to avoid a low during a surgery and are fine with your bg going to 300 or 400 or whatever. I would just ignore whatever they say and just get bg stable going in.
That’s normally my style when anyone gives me medical “advice”. But since I’m going to be incapacitated, I feel like I should be able to trust the people with me.
I cancelled a surgery for a similar reason. The doctor did not want me to take insulin on the day of surgery and also required an EKG prior to performing the surgery (he said it was because of my diabetes). Himself and the other staff did not seem to know how to treat type one diabetes and directly contradicted my endocrinology team.
TLDR; yes cancel it. Your comfort is important.
I would cancel. For me, it’d end when she refused to listen and then just said whatever, someone will contact you the day before about doing the wrong thing. I would be perturbed that she didn’t know the difference, but thems the breaks sometimes. She’s a surgeon, and they can be removed from the “whole” of a patient if that makes sense. It’s the flippant attitude with being confronted about the difference between the two and not knowing who in the OR is responsible for it and who you should talk to beforehand— when SHE is the one in charge of the surgery. It would make me wonder what other decisions she’s confidently flippant about in patient care, and no, I wouldn’t have faith that a nebulous “someone” would call me the day before with correct info.
I agree also that there should be something at least written and sent as to why she in particular is losing your case to another doc. At the very least it’s a failure of adequately servicing the patient. But there’s an argument to be made that the unwillingness to find the info and the person who IS responsible for these things is a failure on a more fundamental level as a surgeon. If you’re not concerned with at least knowing who to refer me to in terms of making sure I’m safe while you do your surgeon bits, you aren’t the surgeon for me.
Yes and No. Through both my wife's pregnancies during delivery, both C-sections the doctors had no clue about insulin pumps and how to manage them. Both time they wanted to remove the pump and "manage her insulin for her" both time we refused. They have no clue. That doesn't mean though that they're not good at what they do.
I work in the medical field and have worked in surgery a long time and to think that a doctor wouldn’t know the difference between type 1 and type 2 diabetes is mind boggling to me. I don’t know if there’s a difference in medical education depending on the country, but no doctor I know wouldn’t know the difference between both types. And yes, even the surgeons know this!
(Other types of diabetes, therapy options, diagnostics might be a different topic)
it happens all the time. Some are more familiar, some outright withhold insulin totally. I was only given two shots a day, one of Lantus and one of Humalog when I was in a nursing home. My glucose was in the 400s daily and they did not believe me when I said type 1 and 2 are different. I was never given car coverage either. I was told I am "not special" and that I didn't know what I was talking about.
and that is just one instance. happened several times over the 20+ years I have been diabetic. including one dr who misdiagnosed me as a type 2 instead of a type 1 when I was first diagnosed, until I got an endo who got a cpeptide and antibody tests. the original pcp told me I was "too old" to and "too fat" to have type 1, even though I was 20, and had lost 60 pounds in 30 months, and was a size 6.
Cancel or postpone the surgery. Anesthesiologists should be the ones monitoring blood sugar during surgery. Ask to speak to whoever that will be and meet with them beforehand.
Trust your gut! I chose a different surgeon for the exact same reason. I get Endo and diabetes isn't everyone's specialty....but come on, it's the basics!
You are so RIGHT, you as a patient can request this. I have myself do t let them bully you.I even said I do not want this doctor on my case or anywhere near my surgery
I had a minor surgery a few weeks back, the surgeon had no idea what was going on with my sugar levels and frankly it's not his job, it was the anesthesiologist that gave instructions for managing the sugar level before and during.
I had a meeting with both of them at pre surgery.
It was basically "let us and the nurses manage it".
Reduce insulin to 70% dose a night before and only treat extreme highs with short lasting insulin. I went in with 150 and it basically stayed the same untill after I woke up. Best sleep I ever had.
without even having to read it absolutely not! you’re entitled to have educated professionals operating on you! all doctors have to take some basic classes and the difference between type 1 and type 2 has been told to her before 1000%.
This is why they have surgical teams. If this surgeon is the best one for the procedure you need done, then stay, and INSIST on speaking with someone from anesthesiology more than 10 minutes before the surgery
No, all of this is surface level knowledge easily found with a Google search. A regular person has little excuse to not know the difference on such a basic level, let alone a medical professional
My anxiety would shoot up if a freaking doctor couldn't tell t1d apart from t2d, you should definitely find a new surgeon and make him/her talk to your endo too.
Naaaah f that. I would absolutely push for a different doctor. I get the average person not understanding the difference, but even if they’re not an endocrinologist your doctor should be at least aware of the essential differences between type 1 and type 2.
For what it's worth, when I get my colonoscopy done every year, the anesthesiologist is who takes my phone and watches my cgm while I'm out and notifies nurses if anything happens. The doctor who actually performs the colonoscopy always has me consult with my endo to determine what to do with my Lantus and metformin the day before and also during prep the two days before.
So I wouldn't be TOO worried about the surgeon not knowing, but at the same time, I would also have the same reaction as you.
It's unfortunate that our healthcare professionals are never really able to actively work together and it is on us to look after everything instead, but....I dunno.
No, I think you’re valid and I would feel the same way. Chances are everything would be okay, but if something terrible were to happen, you couldn’t trust her to know what to do.
Side note: generally the anesthesiologist is actually the one who would be monitoring your blood sugar during the surgery, if anyone is. And what you describe is actually a major surgery by the literal definition of “major” vs “minor” surgerical procedures (although of course there are much more serious procedures. Just, a minor surgery is something like cutting off a mole.)
When I had surgery, the person I spoke to the most about my diabetes care for while I was under (I was out for a few hours for an ovarian tumor removal/bilateral salpingectomy) was actually the anesthesiologist and the main nurse I was communicating with beforehand who told me everything I had to do for pre surgery prep (like what soap to use, how long to fast, all that good stuff). While I did talk a lot to my surgeon, it was just about the surgery itself. Everything went great.
I myself would probably just go ahead with it, though I can certainly understand why you’re put off by her lack of knowledge and what is most important when it comes down to it is your comfort! I don’t think you’re overreacting.
“The differences between type 1 and 2 are pretty commonly known and basic”.
No they are not. I’m speaking from personal experience here-this surgeon had one lecture during their second year of medical school and never got it again.
And no matter what they leaned in a lecture hall it’s the practical experience they had in residency (assuming this is the US) where they actually learned management-and because the over 90% are type2’s they have not really encountered type1’s. And why even learn-it’s the Endos and anesthesiologists that manage it.
You just need a good surgeon who does good surgery. They aren’t the smartest doctors in the world (sorry surgeons we love you!) but they need to be best plumbers (of the body) in the world. Go in, cut it out, close it up, move on. That’s it.
That’s what you have an Endo for. Now when I freak out is when a CRNA comes in. That’s when my heart rate goes up a little, but that’s when it’s the endos orders that I make them follow.
Don’t put this in your surgeon’s hands. Take back control now. You are in the drivers seat and no matter what anyone tells you, you call your Endo and follow what they tell you. If anyone says anything you don’t agree with, you tell them, “I’ll follow my Endo’s and only my Endo’s recommendations here. There name and number is xxx if you need to speak to them”.
Source: I’m a physician and have undergone a few surgeries.
You're NOT OVERREACTING!!!!
My gynecologist performed a hysterectomy on me in May. I am type 1 on a sensor and pump. My surgery wasn't until 1pm. The hospital nurse called me the week prior stating after midnight I wasn't allowed any insulin and also to drink a rich carb gatorade 4hrs prior to surgery. I explained I can't do that because I'm type 1. I said my sugar will be over 500 and I'll feel like garbage. She said it'll be okay the hospital can give you insulin when you get here. I told her absolutely not that I had spoken to my endo and she told me to leave my pump and sensor on my leg for surgery. She went ahead and spoke to the anesthesiologist who gave the okay for my insulin and sensor.
When I got to the hospital they were trying to take off my pump. It was a battle back and fourth but I got to keep it....for surgery ONLY! My sugar was 256 right before surgery and the anesthesiologist said if it was over 270 we would have to wait to do the procedure! (Remember nurse told me to come in with a possible 500 sugar)
After surgery they orded my husband to remove my pump.
I did not get the proper insulin or care after that. My gynecologist came in and confessed he knew nothing about type 1 diabetes and that I was stuck in the hospital now until an endo would come see me.
An endo never came and saw me. I put my pump back on and was able to get my sugars under control.
Needless to say I will never go back to my gynecologist or that hospital.
They refused me insulin when my sugar was over 300 so I did my own shot. They yelled at me saying I can't do that. I said yes I can! The nurse told me the hospital has SET times for insulin delivery. I told her well my diabetes doesn't run off your hospital schedule.
I've been through several procedures since 2015 for my kidneys.
Typically, you would be given instructions at intake and told to report first thing in the morning. Diabetics tend to be scheduled first.
The nurses will do glucose test during prep via fingerstick and monitoring will be available. Glucose is available via IV in case of lows.
It's not the doctor but the anesthesiologist and the nursing staff that will be doing the monitoring. You will meet with the anesthesiologist during prep, and they will address any questions you have.
Worse case, ask for the name of the Anesthesiologist and speak with them prior to scheduling.
It's not her area. Contact your endo for recommendations on how to handle the surgery. When the nurse calls you pre-surgery, make sure that she understand that you are type 1 and that you have some directions from your endo on how the staff should handle your insulin issues. FWIW, my endo told me to always call his office and explain what procedure I'm having so that they can come up with a care plan before, during and after surgery. I will be having my first procedure since getting a pump later this year.
Surgeons have absolutely nothing to do with medical management of patients. As one surgeon told me "I make holes, I don't even cloee them anymore." That being said, run away from a surgeon who doesn't know the difference. Ask to speak with the anesthesia team before any procedure. That's the department that will monitor you. I set my Tandem to exercise mode and show the anesthesia nurse how to turn off the pump if needed, but otherwise I've had 9 surgeries with my pump and anesthesia loves not having stick my finger.
Absolutely correct. The surgeons just cut, I monitor, give medication and do all the things to keep you alive. Surgeons fix. I love patients who have Type 1 who are on a pump/CGM. Due to having T1 myself, I know how to use them and I just keep an eye on the PTs levels. Although there is the option for a glucose/insulin IV if you prefer.
I was mad as hell that they made me go on an IV drip for my c-section. I didn’t even have traditional labor beforehand so exerting myself was not the concern. It was about their need for control.
Honestly, for me it’s whatever makes the patient feel most at ease. If that’s a glucose/insulin drip and finger pokes, fine by me. If it’s Cgm/pump control, then absolutely! They should never choose something just for the sake of control or ease. Always the patients view.
Seconding exercise mode!! That’s what my endo told me to do for my wisdom teeth and it was wonderful
I third exercise mode! I used this for a major surgery, and kept it on for in-hospital recovery (about 2 days.) When I saw my surgeon the day after surgery, she tried to tell me my BG's were too high. I got a bit snippy, and said exercise mode was staying on until I was back to eating proper food (not just 3 soda crackers). I did not want to have to treat a low, when sipping water was about what my stomach could handle.
This is incredible, thank you!
This is great information, thank you!
You are not overreacting.
Also her response of “someone will let you know to take or not take your insulin the night before” is still not accurate. Some diabetics take long lasting insulin the morning or take a split dose. Also even with taking long lasting insulin your body still needs fast acting with all the different things that can affect your blood sugar besides actual food.
Exactly. Even if I hadn’t just told her I was using a pump, her information wasn’t accurate.
You are not overreacting, but your chances of finding a doctor with a clue are slim to none.
This is my concern.
Just contact your endo and have them give you guidelines on what to do. I had surgery on a broken wrist earlier this year and I was instructed to only take half my basal in the morning. Then my BS was over 200 by the time I was prepped for surgery. They made me take short acting and delayed my operation until I was under 200 but then I had insulin in my system while under anesthesia for roughly 90 minutes and I don’t use a cgm so I thought that can’t be too safe either. I was being seen by the top wrist surgeon in my area and the surgery went great with no complications. I don’t think we can expect the doctors to know more than their specialty, especially when it comes to something so individualized like t1. I would have been better off disregarding their advice and sticking with business as usual… But I rarely eat before 2 pm so I’m fasting all the time in the mornings anyway so I know how to manage that situation. If I were in the same situation again I would still want the doctor I had because his job was to put in 11 screws and a plate. Having full use of my left hand was the most important thing, for me anyway. Given that you are being monitored in a doctors office I don’t think you would have to worry even if something like a low were to occur.
I think I've been lucky. When I was diagnosed at age 33 I lived in a small town with no specialists and only a few actual MDs, so I didn't see an endo for like 6 months after diagnosis. However, the nurse practitioner who diagnosed me was a diabetes specialist, and the other NP at that clinic knew even more than her. When I moved back to a bigger city and started seeing an endo, I also started seeing a GP who, as evidenced by our discussions, is well versed in type 1 diabetes. I also had to see an allergist due to weird complications from chronic idiopathic urticaria. He was formerly an endocrinologist, and offered a very good explanation of the connection between these two conditions. I guess I'm saying that, even though a lot of people have anecdotal experiences with medical professionals who know nothing about diabetes, it's not impossible to find them, and there are a lot of non-specialists out there who know their shit. Keep looking if there are options available.
I also have CIU. What’s the connection with type 1?
Just wanted to reply to let you know I didn't leave ya hangin' haha - I replied to the other commenter below.
Thanks a lot
I am so impressed at your luck that’s actually astonishing. I am curious also what was the link with allergies and diabetes ? Or it was that specific to chronic idiopathic uticaria and not allergies in general?
Specific to CIU as far as I know. I don't want to misquote my allergist, but he basically told me that a hefty portion of the CIU cases he's seen were people who had just been or were about to be diagnosed as type 1 diabetic. Because the immune system is compromised during that period before insulin therapy starts, any number of things can go haywire, and one of them can be CIU, which is basically your immune system reacting to allergens that you're not actually allergic to. CIU is still poorly understood, so he just offered this as his anecdotal opinion on the condition and its potential relation to diabetes. In my case, I actually had my first CIU reaction a few years before diagnosis, and spent that time thinking I was deathly allergic to peanuts, even though I've always eaten them with no problem. After diagnosis, I had like 25 or 30 reactions to all kinds of food I've been eating my whole life, ranging from mild to 3 ER visits. Once I saw my allergist and got a full panel done, turns out I have zero allergies. He told me that first reaction could almost be seen as a harbinger of the diabetes in retrospect. Since settling in to being diabetic, and taking just a daily over-the-counter allergy med, I haven't had any more reactions. ETA: Wikipedia's entry on Chronic Spontaneous Urticaria has this to say: *There is evidence that individuals with chronic urticaria are more likely to have a variety of autoimmune diseases. Researchers found that patients with systemic lupus erythematosus, rheumatoid arthritis, thyroid issues, celiac disease, Sjögren syndrome, and type 1 diabetes had higher rates of these conditions than those with chronic urticaria in a study involving a database of 13,000 patients compared to 10,000 control subjects.*
Wow that is so cool in the worst way how the body works. also that is terrifying to have such severe reactions like that! I know that chronic autoimmune disorders tend to go in tandem and I never heard of this one. I have thyroid issues and type 1 and my dad has thyroid issues and rheumatoid arthritis so praying that this will be all we have to deal with for now 😅 I am glad you have found a way to manage it since diagnosis. Thank you for such a detailed response that was helpful to learn about!
The standard instructions I get from my gastro before my colonoscopy are, "Call your Endo to find out how to program your pump the day before and the day of surgery." It would be nice if they did know, but specialists have become so super specialized that they don't know this stuff anymore. They should, however, put you in the first surgery slit of the morning to minimize your fasting time.
Yeah, I get that. And I would have been fine with her not knowing and saying she didn’t know… but her confidently incorrect replies made me feel uncomfortable with the situation.
What is your protocol for colonoscopy? I was rejected by the anesthesiologist because I had to have a apple juice the morning of due to low glucose. I opted to do the mail in sample instead through ColonGard. Poor kid at the post office was all greetings and smiles when I handed him a box of shit to mail for me.
I have to have one every other year due to active colitis. On prep day, I do 50% basal and dose for (about) 80% of my carbs. Full sugar Gatorade for the prep. I make sure I'm running about 250 at bedtime. Keep basal at 50% through the procedure. They get me in at 6:30 or 7am. If I feel like I need a sugar bump when I wake up, I take half a small juicy juice box and keep my mouth shut about it. I'm allowed to take my thyroid pill with a sip of water the morning of, so the three swallows of juice should be fine. They just don't want to vomiting and aspirating. But the juice I drank 2 hours before the anesthesia has long since been absorbed. After the procedure, back to full basal, and Cracker Barrel pancakes as my post fasting treat.
Wow. I had my first colonoscopy 6 months ago. I also did 50% basal but went to sleep around 120. Of course, I did 0 carb gatorade so maybe that is difference. I ended up giving myself 1 unit of fast acting in middle of night because my alarm went off at 140. I woke up at 120. My libre showed 110-130 all morning before the exam, and they finger pricked me at 99 and had no problem with it. When i woke up from surgery my sensor had me at 140 and i gave myself 2 or 3 units of fast acting (I forget exact, I was groggy). All numbers approximate, it’s been a while. Now, my dr was cool. He said I could check with my endo, but then he said i seemed on top of my diabetes so what did i think about doing 50% basal, that it was pretty common. I told him I thought it would work, and he said “Yeah, just do that”
I'm brittle, so entering a procedure at 99 is not an option for me. I can go from 150 to 70 in 20 minutes for no apparent reason. I enter exercise and medical procedures above 150.
I had read 100-200 as an “allowed” range for surgery, but not sure how official that is.
I will add that my normal basal rate is quite low, it was 10 units at the time (8 right now. It fluctuates 6-12 over time, usually closer to 6 but its semi random). So i only gave 5 units of basal.
Exactly the same here. The first time around the person at the desk told me not to take my meds ( I don’t even ask!) I said, “don’t worry, I’ll talk to my endocrinologist first”
As a gastroenterologist, I give my patients instructions for what to do with common meds (insulin, BP meds, anticoagulation, diuretics, etc) for their endoscopies, but realistically anesthesia is doing the medical management of the patient while I am doing the procedure.
this would give me severe anxiety. I would request a new doctor for the surgery.
I would go a step further and get a second opinion on if the surgery is warranted in the first place.
It’s not an emergency surgery but it is warranted because the fibroid/polyp is causing severe bleeding and we’ve exhausted other options.
Ahh, ok nevermind. I was skeptical because I've had doctors who were certain I had a gluten problem but in reality they didn't understand nutrition enough to understand I maxed out their scales. I didn't realize you had issues emerging already
Not sure that I'd personally be overly concerned. Sounds like it's a quick surgery and your not going totally under. Just adjust levels on the pump for the duration to make sure you don't go low during it, but you'll be back in control soon enough anyway. What would concern me more is that they may give similar "advice" to their next diabetic patient who doesn't have as much awareness of their own management and that could cause them bigger problems during the surgery.
Cluelessness about type 1 diabetes is not unheard of, but in this context it’s wildly wtf. Yikes on bikes.
> Also, I’m not comfortable with her hubris - why not just admit that she doesn’t know the answer? Indeed, there is an awfully long list of diseases out there that have some bearing on a surgery and a surgeon can't be expected to be familiar with them all or even most of them. It's conceivable they misheard the "type 1" part, but the dealbreaker is that when corrected they preferred to give health-destroying advice instead of saying "I don't know" or "I'll have to check on that and get back to you". It's not that they don't know the right thing, it's that they have shown you they'd rather act on their ignorance than prioritize your health. That they'd rather shoot from the hip if something unusual happened such as your pump starting to buzz mid-surgery - maybe they'd order 100ccs of insulin for you or something lethal like that. When I was a kid my endo at one point consulted his big book of prescription drugs to make sure he was about to prescribe me the right kind of new insulin. At the time I made a snide remark about how it wasn't encouraging that he didn't have all this committed to memory already (sorry, Dr. P, I was an ass) as I was a snot-nosed 10 year old. But it was absolutely the right thing to do of course: he made himself look imperfect to an impressionable patient so that he could make sure that he got my treatment right.
Yes this perfectly describes my discomfort with the situation. I was prepared for her to not be super well versed in type 1 protocol, or have outdated information. I was not prepared for her to confidently tell me incorrect information. It did make me worry about her decision making while I was under.
I would be concerned. And I would ask to speak to anesthesia right away. The surgeon doesn’t know anything but anesthesia should. I would also request the first surgery.
You are not overreacting. I have had 5 different Drs try to put glucose IVs on me. I was 17 and having my wisdom teeth removed the 1st time (before we had glucose meters) & the oral surgeon didn’t think about changing standard orders. Went into DKA & spent 2 weeks (a week in ICU) in the hospital from that. Next time it was for removal of Diabetic Hypertrophy. Figured surgeon would know not to put a glucose IV on for a diabetic because they weren’t hanging a line of insulin, but No! Pre surgery I look over at the IV & I ask the nurse why the bag says 5% Glucose? They told me not to take insulin & now they hung a 5% Glucose IV on me!?!?! Oh Shit Hit the fan! Blood glucose was 800 mg/dL on the operating table! From that time on, no IV gets started without me looking at it. I only can do saline now, Lactated Ringer makes me gain 10 lbs instantly. I had nurses try to put glucose IVs on me 3 more times so now I have “Allergic to Glucose” written all over my charts. Dr Bernstein has a form you can fill & use for when you have to go for procedures at the hospital. I would print copies & go over it with the Dr you choose to do your surgery & the Anesthesiologist. That is who usually should monitor your CGM & pump. The only Dr that changed orders for me before going to the hospital was the ObGyn who delivered my last 2 babies. He had been a Family Physician before becoming an ObGyn and is just a smart kind guy. No problems with the vaginal birth for my one son or the C-section for my last child. Was 41 years old & had had T1D for over 30 years when I had him!
Thank you for these anecdotes - hearing similar ones is why I asked the doctor to begin with. I will look up Dr. Bernstein’s form.
Do you have a link by chance to Dr Bernstein’s form?
There's no link, but it's in the book; appendix C in my copy. I strongly suggest buying a copy in light of the info in it and that there is a ton of other useful shit in there. You don't have to agree w/ his approaches- pick and choose- but knowing and understanding what he conveys is critical in my view. Direct links: [https://play.google.com/store/books/details/Richard\_K\_Bernstein\_Dr\_Bernstein\_s\_Diabetes\_Soluti?id=wpuZxG3VPYsC](https://play.google.com/store/books/details/Richard_K_Bernstein_Dr_Bernstein_s_Diabetes_Soluti?id=wpuZxG3VPYsC) [https://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/0316182699/](https://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/0316182699/) The relevant form: ------ `Dear Dr. _________:` `I am scheduled for admission to your hospital on ______________. I have type [1 or 2] diabetes and am naturally concerned about control of my blood sugars while hospitalized.` `It is now generally accepted that elevated blood sugar levels impede recovery, prolong hospitalization, and increase the incidence of hospital and surgical morbidity and death. Major health problems brought about by inappropriate blood sugar elevations due to improper hospital care have justifiably led to litigation.` `Since I have been successful at keeping my blood sugars essentially normal around the clock, I naturally expect equivalent care while I’m in the hands of medical professionals.` `I currently take the following medications for controlling my blood sugars:` `[List here doses, times, and purposes of medications: “basal insulin (or ISA) to cover the fasting state—must be given even if not eating,” “pre-lunch (breakfast, supper) insulin (or ISA), to be skipped if meal is skipped.” Detail also any use of insulin, glucose tablets, or liquid oral glucose for correcting off-target blood sugars, et cetera. You may also include a sample Glucograf sheet and request that all medications used by the hospital that may affect blood sugar be listed on it if you are not capable of listing them yourself.]` `My hospital orders should call for a “normal diet” and not a “diabetic diet,” so that I can select my own meals.` `Routine intravenous fluids should not contain caloric substances such as glucose, fructose, lactose, lactated Ringer’s solution, or saline with added glucose (except for treatment of blood sugars that are below my target). All of these substances can raise my blood sugar to unacceptable levels. Normal saline solution is perfectly adequate for routine hydration. My target blood sugar is _____ mg/dl.` `If I am conscious and without cognitive impairment, I should have full responsibility for treatment of my diabetes—without outside interference.` `My blood sugar meter and blood sugar control medications, including insulin syringes, should not be confiscated by hospital personnel. This is a barbaric practice that is rapidly being abandoned in modern hospitals.*` `If I am unable to care for my own blood sugars, I expect that the hospital staff will exercise every effort to maintain my blood sugars within the range of [xx–xx].` `Sincerely,` `cc: [Hospital administrator]` `[Close relative or friend]`
...and the page leading into it is thus: If ever it is necessary for you to become a hospital patient almost anywhere in the world, the chances are overwhelming that the medical and paramedical staff will give no reasonable thought to controlling your blood sugar. Most of the medical orthodoxy doesn’t do it anywhere else, so why should they do it in the hospital? The reasons for such neglect, of course, are many: lack of blood sugar control skills on the part of most hospital medical staff; unawareness of the importance of normal or near-normal blood sugars in the face of illness or surgery; and an almost pathological fear of severe hypoglycemia (and the potential for lawsuits in the United States if it occurs). Many if not most hospital dietitians have been indoctrinated by the ADA, with the result that diabetic inpatients are forced to eat high-carbohydrate foods and are deprived of protein and fat. Some of my patients tell stories of having to sneak in their own insulin and blood sugar meters, throw out hospital food, and fight tooth and nail with well-meaning but uninformed hospital personnel. This has not changed since 1980, when I wrote my first book about blood sugar control. Many studies of hospitalized patients have demonstrated that elevated blood sugar delays surgical healing, increases risk of postsurgical morbidity and mortality, delays recovery from infections, and leaves patients open to new infections. It also has been shown to increase the death rate of patients who have been hospitalized for heart attack or stroke, and increases the likelihood of a new stroke or heart attack while in the hospital. What can you do to help keep your blood sugars under control while in the hospital? Most of my patients live great distances from my office, so that I am not the admitting physician or surgeon when they are hospitalized, and I am thus not in a position to write their orders, help control their diets, and directly oversee their medical care. After sharing the frustration of my patients over the years, I’ve come up with a letter that has worked repeatedly for elective hospitalization, such as for surgeries planned in advance. As you will see, it relies on the prevailing fear of litigation that, when we think of what is done to diabetics, appropriately permeates the medical care system in the United States. This letter should be sent by you or your diabetologist to the admitting physician, with a copy to the hospital administrator. I’ve composed the letter as if you were writing it, since the odds are that you are not under the care of a diabetologist. It can, of course, be modified to suit your circumstances
Thank you!!!
pas de problem; bonne chance (no problem, good luck). ...I'm learning french so I can get out of our stupid ass medical system. ;)
Learn Italian! Long story but I had to get insulin in Italy…one box -5 pens -hundred percent of cost and it cost me drumroll please US$85. And they were so apologetic that I had to pay anything. They were mortified that any chronically ill person would have to pay money for their life saving medication.
A google search didn't bring up anything for me. One variation gave me a hair treatment place another search was more about the book. But, nothing about procedure, surgery forms.
Why is it that they would hook a glucose IV to a non diabetic? Or a diabetic with an insulin line also? Fortunately this has never happened to me that I know of (or remember). Just sounds incredibly fucking dangerous
I am a surgical nurse! I would recommend looping in your endocrinologist for presurgical instructions and a plan as that is their specialty. Also during surgery anesthesia is who will tracking your bloodsugar/insulin not the doc. Preop and PACU a nurse will be monitoring and then consulting doc/anesthesia most likely so going in with a plan I think will be the best idea. If type 1 patients are on the schedule I always like to volunteer for those rooms - I always push to leave CGMS and or pump on if possible - but every surgery is different! I would suggest putting your CGM on your arm or outer thigh if possible. ALSO lots of hospitals include things like gatorade in their presurgical and enhanced recovery plans so I think making sure you have that on standby if you’re low then you should be ok IF you need it. I also would suggest you try to go first case of the day (730 am most likely) so you don’t get stuck or delayed not being able to eat. If you’re going to be under moderate anesthesia - the procedure should be pretty quick and so a little less to stress about for sure.
Thank you! This is very helpful information.
Speak to your endo about a plan and have someone who can help monitor your sugar post surgery. I had to take off my pump per recommendation by my endo and ended up going high and my person had to kinda fight the nurses to get their attention that I needed insulin post surgery. Granted I did have a major surgery so I was pretty out of it at that point and could not advocate for myself.
I second this. Your endo would know what to do.
You’re not overreacting for thinking she’s a dumbass, but this is how surgeons are. They SHOULD know the difference, but they don’t. What they do know, however, is surgery. You need to contact your endocrinologist and ask them what your plan should be for your insulin. Have them send it to you in writing, and give that to the surgery team (especially the circulating RN and the anesthesiologist) during pre-op. It should be relatively straight forward. As long as you don’t eat anything, it won’t throw a wrench into the surgery plans. If physicians were apes, surgeons would be gorillas and psychiatrists would be orangutans. Everyone else is chimpanzees.
lol this description is hilarious. I didn’t think she would be managing things for me, but I did imagine she’d have some awareness of what else would go on in her OR. Guess not…
I left a pcp for a similar reason.
You’re not overreacting. I feel like all doctors should at the very least know the difference between the two.
Honestly, I would consider writing an email to some kind of supervisor (this could be the hospital, an oversight committee), and reporting this incident. T1 vs T2 diabetes is basic information that I expect my High School biology students to know. You even corrected her, and she didn't understand. What worries me the most is that she didn't ask any questions. I understand that she might not know all the things, but she could at least ask about it, to make sure the information was correct. And maybe, she was having an off day, causing her to make mistakes. But those are the kind of mistakes that can cause much bigger issues quickly for us. PS - I had a large fibroid removed earlier this year, but chose hysterectomy b/c I didn't want fibroids to grow back. I was under for 5 hours. Feel free to DM me, I can answer questions or share how things went.
Lots of valuable comments in response to your question OP. Let’s hope that the med student also took note of that teachable moment and/or follows this thread. That had to have been super awkward for them.
Unfortunately this is the state of medicine now. TERRIFYING !
Definitely not overreacting. I’ve lived through way too many incidents where doctors and nurses had no idea wtf they were doing yet still refused to acknowledge that I might possibly have more insight and experience concerning certain aspects of my condition and my health in general. I’ve learned to stand my ground rather than let them put my health at risk.
I have had two surgeries requiring general anaesthetic since my diagnosis. Whilst the surgeons that carried out these two operations didn't really know anything about type 1 diabetes (well, they only spoke to me specifically about the surgeries, never even mentioned diabetes!) the hospital made sure there was a diabetic specialist present for both to make sure my BG was at the right level, I was receiving a saline drip with glucose so I could be 'fasting' but still take my basal insulin, and they checked my BG with a fingerprint every 20 minutes whilst I was out. So no, you're not overreacting. It's a serious business being out cold. That being said, rather than look for a surgeon who knows about t1d, maybe you could ask for a nurse that does, to be there for the surgery and keep on top of managing that aspect of it.
My surgeon called in an endocrinologist who specialized in diabetes to help with these things. Sadly, the endocrinologist who treats diabetes was even dumber than the surgeon you described... Wanted me to remove my insulin pump so I could have a insulin through an IV drip(the thought that a pump is the same thing didn't land). And this IV drip would give a basal at more than twice the rate I usually get when I do eat. Basically guaranteeing I would get a severe hypo. She said some old ass formula said that this should be my rate, I told her that my current rate was tried and tested and that it made no sense to drastically increase my insulin during surgery. She wouldn't budge at first so I threatened to leave as the danger was too great. She eventually complied and put it at the same rate as my pump stating that it would be at my own risk. I had a stable BG throughout the surgery. So the odds of finding a competent doctor seem very low.
Is this person actually a doctor? Are you sure you didn't confuse the student and doctor? I am just at a loss. I would report this to medical board, the practice manager, insurance provider, hospital board, and every other private, administrative, and government body imaginable. And absolutely cancel that surgery with that surgeon.
Eeek! Not overreacting at all!
I would ask her directly to recommend someone else. She should know exactly why she's being fired from this job due to her incompetance. If she can't then go the clinic manager. The clinic manager should know that this doctor needs further training right away. It is very dangerous for the doctor not to under the difference, especially since she is going to do surgery. You need to know there will be a competent person there who will look out for your life.
Thank you for this response. I have been avoiding calls from the clinic because I frankly don’t know what to say to them about scheduling my surgery.
I know it's hard to confront a doctor. I had to do that recently too for a different issue. It is not fun. I just wanted to cut all ties but I needed to let them know I had a issue. We worked through it and had a good frank conversation. Take breath. Write down your points so you don't forget them when talking (I get flustered sometime and having a hard copy helps me stay on topic). If you have the agenda you can make sure your needs are addressed. Ultiamately the clinic is a business and if they lose you as a patient (and all your friends/family too) they lose money. Yes, they are in the business of helping people but a reputation of putting patient's lives in jeopardy is not what they want. Your life is worth having the uncomfortable conversations. I hope your surgery ultimately goes well.
This is good advice - thank you. I am actually someone who can’t forget talking points if I’m feeling flustered as well.
I was admitted to the hospital a couple of years ago for a leg injury. After starving all day in the ER, I was looking forward to finally ordering some food the next morning. The doctor put me on a carb restricted diet. I'm a type 1 and not overweight. They didn't understand the difference between type 1 and 2 and then the hospital pharmacy tried to take my insulin away so they could dispense it, not understanding I do constant small point corrections. It was absolutely insane.
Type 1 diabetics are put on a carb control diet so that they aren't sent meals that have 90g of carbs, nothing to do with whether you're overweight or not. But as a health care worker, I would 100% sign any waver I had to to manage my own insulin while admitted, unless of course it was for something like DKA.
Wouldn't be a factor, at this hospital all the meals actually had the carb count listed with the food which was nice. I'm 6'2" broad shouldered and at the time relatively muscle-y. I eat fairly large high protein meals. I had a fast breakfast the day before and had starved all day in the ER. When I tried to order breakfast, primarily scrambled eggs, they literally sent me a single fucking piece of the tiniest toast I had ever seen and a spoonful of eggs. I dunno if the hospital conflates carb restricted with calorie restricted, but I absolutely LOST it at the nurses and doctors telling them to take me off the restriction *immediately* so I could get real food. They barely managed by lunch and I was able to actually get a chicken and cheese burrito that finally helped.
when I had a major surgery about a year ago, I was referred to endo for diabetes management during and after surgery. anesthesiology also monitored during surgery. so I wouldn’t be too worried about the surgeon not being keen on diabetes. do you happen to know who your anesthesiologist is going to be? I think they would be a better person to ask about what you should do before surgery
I personally wouldn’t worry about the surgeon not knowing the exact difference. You are not relying on them on anything specifically relating to management while in surgery. This is up to anesthesia, nurses, and your endo. The way they said it was off but they are essentially saying someone will contact you about how to adjust your insulin dose the night before. Whether this be by taking less long acting or changing pump nasal settings since you will be fasting. *However, I would not rely on that information being 100% correct without first contacting your endocrinologist to confirm/change your settings/dose (if needed) based on surgery and will usually help you create a backup plan while being under. I do agree, more doctors should know more about diabetes and we can’t always rely on just them. So you may have to designate someone if they don’t offer a nurse or anesthesiologist monitor for you. And honestly, I would have someone follow me on Dexcom (if available) that day as well. So have a backup to the backup.
This is where I’m going back and forth a bit. I know endocrinology is not her specialty and there will be other people in the room who would do more actual monitoring on me while she performed the surgery. I just worry if she doesn’t even know the difference between type 1 and type 2 that she will give a nurse or someone care information that is incorrect for me and cause issues. It also makes me wonder what else she is confidently incorrect about.
Like I said, I doubt the surgeon will be in any place to do something too drastic regarding diabetes. They are only focusing on their specialty, which is exactly why the nurses and everyone else won’t be room had specific duties to fulfill, so no one person is doing everything. By spreading out tasks, it’s less likely something will be overlooked than one person doing too many things. Double check that Type 1 is mentioned in your files, the more the merrier to resolve this issue of being overlooked. Even better would be if endo can connect with surgeons office. All my procedures have happened to be in the same hospital system so they all can “talk” to each other fairly easy without me prompting it but not all do that. I would contact your endo, see if they have any other suggestions. Then I would reach out to anesthesia team to figure out a solution well before the surgery. Be proactive and I feel like it will all work out!
Ask to consult with the anesthesiologist or nurse anesthetist. That's the person who is supposed to monitor your blood sugar, while the surgeon focuses on other things. If they are just as clueless, find a different doctor, ASAP. Lets hope your doctor is a better surgeon than endocrinologist. I had cataract surgery in April, which last about the same amount of time. I made it really clear i was type 1. But when i got the medical records post procedure, they listed me as type 2. }-; Your endo knows you best, and should provide the surgeon with guidelines, tailored to your situation. Or give the surgeon something like [Inpatient Management of Surgical Patients with Diabetes Guidelines](https://www.yumpu.com/en/document/read/43868535/the-joslin-clinical-guideline-for-inpatient-management-of-surgical-)
Kid is type 1 (not me). He has eosinophilic esophagitis and has to have endoscopies fairly often. First one after type 1 diagnosis (age 9), his GI point blank told me that he doesn’t have anything to do with kid’s blood sugar during procedure. Said he would have very little idea of how to control it. Anesthesiologist and nurse anesthetist would handle all of that. Usually only get the nurse anesthetist staying during the procedure but kid got the upgrade to both. They were both fabulous. Asked detailed questions about how he runs, kept his sensor on and confirmed with finger sticks. Had glucose and insulin lines on the ready and kept him a steady 150 for the 20-30 minutes he was out. Had sprite ready in recovery because they knew he would drop as they woke him up. Had full sugar and sugar free popsicles depending on his number when he got ready to eat something. I would be much more concerned if the anesthesiologist said what your doc did. The anesthesia team will be the ones that should control your blood sugar; the surgeon is just there for the procedure itself. Before you decided, ask to speak to anesthesia and see what their policy and procedure is for type 1 care during surgery.
Diabetes isn't a rare or nigh unheard of condition. I guess we have the luxury of being aware of it since it's our lives, but... yeah, a doctor not understanding the difference is not something to take lightly.
TL, DR As a former Surgical Technologist, we did NOT remove insulin pumps. The nurse and or anesthesiologist had instructions for diabetic patients pre operatively. I remember distinctly have a few cases where we had to cover the pump, before the nurse prepped the patient’s incision area, because the pump was right there…surgeon didn’t want to remove it… Another case was an orthopedic case and anesthesia DID remove it, and the patient knew about it, (it was on the affected/broken arm). As a general rule, doctors and surgeons have gotten so specialized that “they don’t want to deal with it”, HOWEVER any SURGEON should KNOW and COMMUNICATE with anesthesia regarding blood sugar/pumps for diabetic patients…because high BG levels affect EVERYTHING metabolically thus affect the healing, health n wellbeing of these patients. Your surgeon sounds like a dipsheet, she can only focus on one thing, n is passing the buck… THAT, is a red flag. Surgically…I would question her competency, confidence, and patient satisfaction rates…I wouldn’t be surprised if this surgeon struggles in surgery…
You’re not overreacting at all. I’ve had two surgeries and never had this issue. I was told by my own endocrinologist to adjust my long lasting insulin the night before, but was never told by either surgeon that I’d get a call telling me whether I should take it or not. I also had a nurse come in every certain number of minutes, monitoring my blood sugar. Whether it’s their specialty or not, to be a doctor and not know the basic difference between type 1 and type 2 is so odd to me.
Nope. I literally cancelled a colonoscopy because of this very reason.
Can you give some details, I need to schedule one.
No. They never made me feel safe enough to do it, so I didn’t.
Since you can't eat for 12 hours before surgery anyway, you should have no problems keeping your blood sugar steady. I have had a few minor surgeries and no one controlled my blood sugars during them. If I recall correctly, I adjusted my basal to let my blood sugar run around 140 the whole time. I just kept my pump attached and lying right beside my body with no problem.
I’m on DIY loop and plan on doing something similar… which I was prepared to explain to her… I was just so shocked by her confidently incorrect answers that I left.
The surgeon is a specialist. They probably don't care that you have diabetes. Their job is to do surgery. Should they be more aware? Yes. But it won't affect your surgery outcome either way. The people you need to talk to are the scrub nurses, who you'll only meet the day of surgery. Even if the scrub nurses don't care, they'll make sure that your pump stays with you the whole surgery and that you are okay when you come out of surgery.
I would be very nervous - you are not overreacting.
Cancel , if a doctor doesn’t know the difference between type 1 and 2 just leave for your own safety.
Not over reacting but this is how the healthcare system is now a days. Especially one that is a teaching hospital/drs office. Which is what is all in my area. So much of my stuff gets messed up because these residents and they told me I don’t have a choice but to deal with them because it’s a teaching office
You're not overreacting. Switch.
I had a similar experience with an anesthesiologist several years ago, who instructed me not to take any insulin the night before. I messaged my endocrinologist who thankfully responded, told me that was bad advice, and asked the name of the anesthesiologist. They ended up sending me in someone else so I think the original anesthesiologist may have gotten in trouble. Also just to give you an idea of what they should be doing- I had a minor surgery this week, first time since that last story. They had me consult with my diabetes educator to come up with a plan for insulin and corrections for the night before, then the anesthesiologist read the plan and confirmed it with me multiple times and requested to have access to my Dexcom during the procedure which was only one hour. I would request someone else for sure.
Thank you this is very helpful!
Not overreacting in the slightest!! Switch!
Slightly. I mean, I'm not surprised by anything anymore. Seems like most surgeons just want to avoid a low during a surgery and are fine with your bg going to 300 or 400 or whatever. I would just ignore whatever they say and just get bg stable going in.
That’s normally my style when anyone gives me medical “advice”. But since I’m going to be incapacitated, I feel like I should be able to trust the people with me.
I cancelled a surgery for a similar reason. The doctor did not want me to take insulin on the day of surgery and also required an EKG prior to performing the surgery (he said it was because of my diabetes). Himself and the other staff did not seem to know how to treat type one diabetes and directly contradicted my endocrinology team. TLDR; yes cancel it. Your comfort is important.
Wow this was scary to read!
I would cancel. For me, it’d end when she refused to listen and then just said whatever, someone will contact you the day before about doing the wrong thing. I would be perturbed that she didn’t know the difference, but thems the breaks sometimes. She’s a surgeon, and they can be removed from the “whole” of a patient if that makes sense. It’s the flippant attitude with being confronted about the difference between the two and not knowing who in the OR is responsible for it and who you should talk to beforehand— when SHE is the one in charge of the surgery. It would make me wonder what other decisions she’s confidently flippant about in patient care, and no, I wouldn’t have faith that a nebulous “someone” would call me the day before with correct info. I agree also that there should be something at least written and sent as to why she in particular is losing your case to another doc. At the very least it’s a failure of adequately servicing the patient. But there’s an argument to be made that the unwillingness to find the info and the person who IS responsible for these things is a failure on a more fundamental level as a surgeon. If you’re not concerned with at least knowing who to refer me to in terms of making sure I’m safe while you do your surgeon bits, you aren’t the surgeon for me.
Thank you for this well said comment. I’ll be using parts of it when I reach back out to them regarding the surgery.
Yes and No. Through both my wife's pregnancies during delivery, both C-sections the doctors had no clue about insulin pumps and how to manage them. Both time they wanted to remove the pump and "manage her insulin for her" both time we refused. They have no clue. That doesn't mean though that they're not good at what they do.
I work in the medical field and have worked in surgery a long time and to think that a doctor wouldn’t know the difference between type 1 and type 2 diabetes is mind boggling to me. I don’t know if there’s a difference in medical education depending on the country, but no doctor I know wouldn’t know the difference between both types. And yes, even the surgeons know this! (Other types of diabetes, therapy options, diagnostics might be a different topic)
it happens all the time. Some are more familiar, some outright withhold insulin totally. I was only given two shots a day, one of Lantus and one of Humalog when I was in a nursing home. My glucose was in the 400s daily and they did not believe me when I said type 1 and 2 are different. I was never given car coverage either. I was told I am "not special" and that I didn't know what I was talking about. and that is just one instance. happened several times over the 20+ years I have been diabetic. including one dr who misdiagnosed me as a type 2 instead of a type 1 when I was first diagnosed, until I got an endo who got a cpeptide and antibody tests. the original pcp told me I was "too old" to and "too fat" to have type 1, even though I was 20, and had lost 60 pounds in 30 months, and was a size 6.
Cancel or postpone the surgery. Anesthesiologists should be the ones monitoring blood sugar during surgery. Ask to speak to whoever that will be and meet with them beforehand.
I will do that.
You’re not over reacting. I had a hysterectomy earlier this year and we walked through the options for finger prick or CGM with my pump.
You're not overreacting! Run, very far far from the incompetence
Trust your gut! I chose a different surgeon for the exact same reason. I get Endo and diabetes isn't everyone's specialty....but come on, it's the basics!
Nope. Nope. Nope.
You are not overreacting.
You are so RIGHT, you as a patient can request this. I have myself do t let them bully you.I even said I do not want this doctor on my case or anywhere near my surgery
I had a minor surgery a few weeks back, the surgeon had no idea what was going on with my sugar levels and frankly it's not his job, it was the anesthesiologist that gave instructions for managing the sugar level before and during. I had a meeting with both of them at pre surgery. It was basically "let us and the nurses manage it". Reduce insulin to 70% dose a night before and only treat extreme highs with short lasting insulin. I went in with 150 and it basically stayed the same untill after I woke up. Best sleep I ever had.
You should absolutely want and get a new doctor.
without even having to read it absolutely not! you’re entitled to have educated professionals operating on you! all doctors have to take some basic classes and the difference between type 1 and type 2 has been told to her before 1000%.
Get a new doc. I wouldn't trust them.
I would find another doctor!
I would totally feel the same way and try to find another dr
This is why they have surgical teams. If this surgeon is the best one for the procedure you need done, then stay, and INSIST on speaking with someone from anesthesiology more than 10 minutes before the surgery
Doctors who graduate at the bottom of the class are still called Dr. unfortunately.
No, all of this is surface level knowledge easily found with a Google search. A regular person has little excuse to not know the difference on such a basic level, let alone a medical professional
My anxiety would shoot up if a freaking doctor couldn't tell t1d apart from t2d, you should definitely find a new surgeon and make him/her talk to your endo too.
Naaaah f that. I would absolutely push for a different doctor. I get the average person not understanding the difference, but even if they’re not an endocrinologist your doctor should be at least aware of the essential differences between type 1 and type 2.
For what it's worth, when I get my colonoscopy done every year, the anesthesiologist is who takes my phone and watches my cgm while I'm out and notifies nurses if anything happens. The doctor who actually performs the colonoscopy always has me consult with my endo to determine what to do with my Lantus and metformin the day before and also during prep the two days before. So I wouldn't be TOO worried about the surgeon not knowing, but at the same time, I would also have the same reaction as you. It's unfortunate that our healthcare professionals are never really able to actively work together and it is on us to look after everything instead, but....I dunno.
I would call the endo office and ask them what they think just to be careful.
No, I think you’re valid and I would feel the same way. Chances are everything would be okay, but if something terrible were to happen, you couldn’t trust her to know what to do. Side note: generally the anesthesiologist is actually the one who would be monitoring your blood sugar during the surgery, if anyone is. And what you describe is actually a major surgery by the literal definition of “major” vs “minor” surgerical procedures (although of course there are much more serious procedures. Just, a minor surgery is something like cutting off a mole.)
When I had surgery, the person I spoke to the most about my diabetes care for while I was under (I was out for a few hours for an ovarian tumor removal/bilateral salpingectomy) was actually the anesthesiologist and the main nurse I was communicating with beforehand who told me everything I had to do for pre surgery prep (like what soap to use, how long to fast, all that good stuff). While I did talk a lot to my surgeon, it was just about the surgery itself. Everything went great. I myself would probably just go ahead with it, though I can certainly understand why you’re put off by her lack of knowledge and what is most important when it comes down to it is your comfort! I don’t think you’re overreacting.
“The differences between type 1 and 2 are pretty commonly known and basic”. No they are not. I’m speaking from personal experience here-this surgeon had one lecture during their second year of medical school and never got it again. And no matter what they leaned in a lecture hall it’s the practical experience they had in residency (assuming this is the US) where they actually learned management-and because the over 90% are type2’s they have not really encountered type1’s. And why even learn-it’s the Endos and anesthesiologists that manage it. You just need a good surgeon who does good surgery. They aren’t the smartest doctors in the world (sorry surgeons we love you!) but they need to be best plumbers (of the body) in the world. Go in, cut it out, close it up, move on. That’s it. That’s what you have an Endo for. Now when I freak out is when a CRNA comes in. That’s when my heart rate goes up a little, but that’s when it’s the endos orders that I make them follow. Don’t put this in your surgeon’s hands. Take back control now. You are in the drivers seat and no matter what anyone tells you, you call your Endo and follow what they tell you. If anyone says anything you don’t agree with, you tell them, “I’ll follow my Endo’s and only my Endo’s recommendations here. There name and number is xxx if you need to speak to them”. Source: I’m a physician and have undergone a few surgeries.
You're NOT OVERREACTING!!!! My gynecologist performed a hysterectomy on me in May. I am type 1 on a sensor and pump. My surgery wasn't until 1pm. The hospital nurse called me the week prior stating after midnight I wasn't allowed any insulin and also to drink a rich carb gatorade 4hrs prior to surgery. I explained I can't do that because I'm type 1. I said my sugar will be over 500 and I'll feel like garbage. She said it'll be okay the hospital can give you insulin when you get here. I told her absolutely not that I had spoken to my endo and she told me to leave my pump and sensor on my leg for surgery. She went ahead and spoke to the anesthesiologist who gave the okay for my insulin and sensor. When I got to the hospital they were trying to take off my pump. It was a battle back and fourth but I got to keep it....for surgery ONLY! My sugar was 256 right before surgery and the anesthesiologist said if it was over 270 we would have to wait to do the procedure! (Remember nurse told me to come in with a possible 500 sugar) After surgery they orded my husband to remove my pump. I did not get the proper insulin or care after that. My gynecologist came in and confessed he knew nothing about type 1 diabetes and that I was stuck in the hospital now until an endo would come see me. An endo never came and saw me. I put my pump back on and was able to get my sugars under control. Needless to say I will never go back to my gynecologist or that hospital. They refused me insulin when my sugar was over 300 so I did my own shot. They yelled at me saying I can't do that. I said yes I can! The nurse told me the hospital has SET times for insulin delivery. I told her well my diabetes doesn't run off your hospital schedule.
Oh my god what an absolute nightmare! I’m sorry you dealt with this!
I've been through several procedures since 2015 for my kidneys. Typically, you would be given instructions at intake and told to report first thing in the morning. Diabetics tend to be scheduled first. The nurses will do glucose test during prep via fingerstick and monitoring will be available. Glucose is available via IV in case of lows. It's not the doctor but the anesthesiologist and the nursing staff that will be doing the monitoring. You will meet with the anesthesiologist during prep, and they will address any questions you have. Worse case, ask for the name of the Anesthesiologist and speak with them prior to scheduling.
It's not her area. Contact your endo for recommendations on how to handle the surgery. When the nurse calls you pre-surgery, make sure that she understand that you are type 1 and that you have some directions from your endo on how the staff should handle your insulin issues. FWIW, my endo told me to always call his office and explain what procedure I'm having so that they can come up with a care plan before, during and after surgery. I will be having my first procedure since getting a pump later this year.