Treatment

Surgery pre-op checklist for people with diabetes

Dr. Bill Quick Health Pro June 29, 2008
  • A checklist can help eliminate mistakes. Seems like common sense, and everyone's aware that airplane pilots have been using pre-flight checklists for years. In hindsight, it's amazing, but surgeons have not been using pre-op checklists routinely. But WHO (the World Health Organization) recently annou...

10 Comments
  • Judith
    Jan. 15, 2012

    Dr.Quick----I can find nothing anywhere about managing my D through the coming TKR ordeal when I have been managing it with diet and exercise only for 4 years. I do Bernstein's 30-35 carbs/day & so far my #s are good (5.2 A1c & healthy lipid profile). I was a dancer for 40 years before fibromyalgia took me out in 1996, so I start the...

    RHMLucky777

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    Dr.Quick----I can find nothing anywhere about managing my D through the coming TKR ordeal when I have been managing it with diet and exercise only for 4 years. I do Bernstein's 30-35 carbs/day & so far my #s are good (5.2 A1c & healthy lipid profile). I was a dancer for 40 years before fibromyalgia took me out in 1996, so I start the ordeal from some basic strength---never stopped my walks or my gentle workouts, despite the pain.

     

    Kaiser's protocols don't address my version of this scourge. They are all oriented to those already on meds. While I acknowledge that may be in my future, I'd like to wait as long as possible!

     

    Thank you for your good work on behalf of us all.....Judith in Portland

    • Dr. Bill Quick
      Health Pro
      Jan. 16, 2012

      Judith:

      Your diabetes pre-op (and post-op) checklist should include all the advice that I and others have given earlier in this SharePost. It's possible that the stress of surgery will cause a jump in your BG levels, and you and the surgical team should be prepared to deal with it if it happens.

       

      As I said, "You and your diabetes doc should think...

      RHMLucky777

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      Judith:

      Your diabetes pre-op (and post-op) checklist should include all the advice that I and others have given earlier in this SharePost. It's possible that the stress of surgery will cause a jump in your BG levels, and you and the surgical team should be prepared to deal with it if it happens.

       

      As I said, "You and your diabetes doc should think through what factors about your diabetes would be crucial for you to survive surgery, and together, make sure that you have your own personal pre-op checklist."

       

      BTW, I haven't seen any followup from WHO on the checklist they proposed in 2008, and will be writing them about where their project is at, and write a blog update today also.

       

      Thanks for writing; best wishes for successful surgery!

    • Dr. Bill Quick
      Health Pro
      Jan. 16, 2012
  • Anonymous
    Anonymous
    Jul. 08, 2008

    I had a series of surgeries and I was on metformin.  I took it the morning of my surgeries. I had a pre-op and seen an internist befor each surgery. No one mentioned anything about going off metformin.

     

    WHY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    • Dr. Bill Quick
      Health Pro
      Jul. 08, 2008

      Why didn't they mention discontinuing metformin pre-op?

       

      I can think of two reasons:

      1) your surgeries were so minor that they didn't put you at any increased risk of lactic acidosis.

      2) they didn't know about the metformin label. The version I just looked at clearly states:

       

      "Surgical procedures-GLUCOPHAGE or GLUCOPHAGE XR therapy should be temporarily...

      RHMLucky777

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      Why didn't they mention discontinuing metformin pre-op?

       

      I can think of two reasons:

      1) your surgeries were so minor that they didn't put you at any increased risk of lactic acidosis.

      2) they didn't know about the metformin label. The version I just looked at clearly states:

       

      "Surgical procedures-GLUCOPHAGE or GLUCOPHAGE XR therapy should be temporarily suspended for any surgical procedure (except minor procedures not associated with restricted intake of food and fluids) and should not be restarted until the patient's oral intake has resumed and renal function has been evaluated as normal."

  • Anonymous
    mombear86
    Jul. 03, 2008

    What suggestions do you have for prepping for a colonoscopy? The first time I had one a few years ago I could barely keep my glucose levels high enough to keep from passing out.

  • Anonymous
    Minnesota Nice
    Jun. 29, 2008

    What about a post-op checklist?  I had gone to a day surgery center for a cataract removal.  It was also the location where they do lots of vitrectomies so supposedly the staff was experienced in dealing with patients with db.

     

    After the surgery was done, I was sitting in the recovery cubicle.  I checked my bg and it was 450, no doubt from...

    RHMLucky777

    Read More

    What about a post-op checklist?  I had gone to a day surgery center for a cataract removal.  It was also the location where they do lots of vitrectomies so supposedly the staff was experienced in dealing with patients with db.

     

    After the surgery was done, I was sitting in the recovery cubicle.  I checked my bg and it was 450, no doubt from the stress.  I asked the nurse to hand me my satchel so I could take some insulin and she patted my hand and said, "oh no you don't - no outside drugs allowed here - you'll have to wait until you get home......." Say what?  I asked to speak with the surgeon, but he was already doing the next procedure.  I asked to speak with the nursing supervisor, but, she never came.

    About 45 minutes later I was allowed to leave and injected in the elevator as we were going to the car.

    Instead of having a nice post-op nap, I was testing my bg every 20 minutes throughout the evening to make sure I wasn't crashing.

     

    The next day I wrote them a letter, cc's to the clinic system and their Patient Relations Department.   I never heard back.

     

    This was then followed up by certified letters, and finally, late one day, the nursing supervisor called but said she was between cases so "had to make it brief".  Sheesh.  Her response was that since insulin is a prescrption drug, it cannot be given (or, I guess, "taken") without a physician approving the dose..........I guess all the MD's were unavailable.

     

    I have never forgetten this experience.  I am furious just writing about it. When I went for my follow-up with the opthalmologist, I told him what had happened.  He said "oh yeah, they've got their own weird protocol about stuff like that........"  ???????

    • Dr. Bill Quick
      Health Pro
      Jun. 30, 2008

      Yes, the WHO initiative discusses post-operative care as well as pre-op.

       

      For people with diabetes who take insulin, post-op care obviously should include orders to  allow frequent blood glucose testing, and appropriate insulin administration. For people who are alert and knowledgeable, it would seem very reasonable to allow you to check your own...

      RHMLucky777

      Read More

      Yes, the WHO initiative discusses post-operative care as well as pre-op.

       

      For people with diabetes who take insulin, post-op care obviously should include orders to  allow frequent blood glucose testing, and appropriate insulin administration. For people who are alert and knowledgeable, it would seem very reasonable to allow you to check your own BG and give your own shots.

       

      I'm very sorry and very disappointed to hear of your experience. You should talk to your primary care physician or endocrinologist, and let them know. Maybe they can shame the surgery center into an apology. And you might also file a complaint with the local BBB, and with your state's Licensing Board for physicians (see http://www.fsmb.org).

       

    • Anonymous
      Minnesota Nice
      Jun. 30, 2008

      Doc - thank you so much for validating my rant.  A year later, I fell on the ice and broke my ankle.  As I was sitting on the sidewalk, waiting for the ambulance, the first thought invading my mind was "they'll take my insulin away.....".  So I took it out of my purse and tucked it into the sock of my non-broken ankle.  When the nursing...

      RHMLucky777

      Read More

      Doc - thank you so much for validating my rant.  A year later, I fell on the ice and broke my ankle.  As I was sitting on the sidewalk, waiting for the ambulance, the first thought invading my mind was "they'll take my insulin away.....".  So I took it out of my purse and tucked it into the sock of my non-broken ankle.  When the nursing assistant was helping me out of my clothes, it fell out and she handed it back to me.  I had to putit in my purse which was whisked away to the hospital safe.   Fortunately one of my nurses was T1 and she pretty much let me do what I wanted.  She said quietly, "well, I'm not supposed to, but I know you know what you're doing".  ..... 

    • Judith
      Jan. 15, 2012

      K---is that you? I'm trying to figure this stuff out in advance of my Feb TKR. Can't get a straight answer anywhere about Kaiser's hospital protocol's for my version of the D!......If that's you: well, Lots of love!!!!!.....Judith in Portland