Question:
Hello, I was recently in hospital due to kidney failure and had to have surgery to create a fistula in my arm and to install a catheter for dialysis in my chest. I am a type one diabetic. The doctor made me stop insulin the night before the surgery and we tried using humalog to control BG the next day without success resulting in very high readings all through the day. Is there a better way? I was thinking about keeping my late night dose of protaphane and skipping the morning protaphane to ensure no hypo during surgery, also stopping the humalog as I will not be allowed to eat from 10PM the day before surgery until after the op is complete. Does anyone here have any experience that may help me? The reason I ask is because the catheter will probably have to be removed in about 2 months, and I want to be able to deal with this a bit better. Regards, Sid. mwillia at mweb dot co dot za
Response:
Sid, smaller doses and often would probably help. If push comes to shove, they could put you on i.v. insulin on a starting dose of 2u per hour. It’s unlikely they’d resort to using any on you during surgery if it’s only a short time. The anaesthetist benefits mostly from knowing what you have. Lie back and enjoy the ‘trip’!
– Hide quoted text — Show quoted text – Hello, I was recently in hospital due to kidney failure and had to have surgery to create a fistula in my arm and to install a catheter for dialysis in my chest. I am a type one diabetic. The doctor made me stop insulin the night before the surgery and we tried using humalog to control BG the next day without success resulting in very high readings all through the day. Is there a better way? I was thinking about keeping my late night dose of protaphane and skipping the morning protaphane to ensure no hypo during surgery, also stopping the humalog as I will not be allowed to eat from 10PM the day before surgery until after the op is complete. Does anyone here have any experience that may help me? The reason I ask is because the catheter will probably have to be removed in about 2 months, and I want to be able to deal with this a bit better. Regards, Sid. mwillia at mweb dot co dot za
Response:
– Hide quoted text — Show quoted text – Hello, I was recently in hospital due to kidney failure and had to have surgery to create a fistula in my arm and to install a catheter for dialysis in my chest. I am a type one diabetic. The doctor made me stop insulin the night before the surgery and we tried using humalog to control BG the next day without success resulting in very high readings all through the day. Is there a better way? I was thinking about keeping my late night dose of protaphane and skipping the morning protaphane to ensure no hypo during surgery, also stopping the humalog as I will not be allowed to eat from 10PM the day before surgery until after the op is complete. Does anyone here have any experience that may help me? The reason I ask is because the catheter will probably have to be removed in about 2 months, and I want to be able to deal with this a bit better. Regards, Sid. You are using protaphane as a basal. Protaphane is a short-lived (rapidly absorbing) basal. When you run out of basal and are barred from replenishing, your liver panics, decides that you have extremely low blood sugar and dumps glucose into the blood. That’s a recipe for instant high bG. The way to keep that basal dribbling into the blood stream without causing a hypo is to use one of the more slowly absorbing basals. Ultratard will work, so will Lantus. A shot of Ultratard at 5 pm, and another at 10 pm will give you a basal dribble until late the next day. A shot of Lantus at 10 pm will give you a basal dribble until the evening of the next day, perhaps a bit later. Regards Old Al (A T1 who shoots 5 units Ultratard at 7 am, 5 units at 5 pm, and 6 units at 9 pm, all on the Western side of the Pond)
Thanks for the replies, they both give me some good ideas, not sure which my doctor will favour but they both can be considered. I will start on my diabetic specialist about changing the protaphane. Regards, Sid. mwillia at mweb dot co dot za
Response:
- Hide quoted text — Show quoted text – Hello, I was recently in hospital due to kidney failure and had to have surgery to create a fistula in my arm and to install a catheter for dialysis in my chest. I am a type one diabetic. The doctor made me stop insulin the night before the surgery and we tried using humalog to control BG the next day without success resulting in very high readings all through the day. Is there a better way? I was thinking about keeping my late night dose of protaphane and skipping the morning protaphane to ensure no hypo during surgery, also stopping the humalog as I will not be allowed to eat from 10PM the day before surgery until after the op is complete. Does anyone here have any experience that may help me? The reason I ask is because the catheter will probably have to be removed in about 2 months, and I want to be able to deal with this a bit better. Regards, Sid.
You are using protaphane as a basal. Protaphane is a short-lived (rapidly absorbing) basal. When you run out of basal and are barred from replenishing, your liver panics, decides that you have extremely low blood sugar and dumps glucose into the blood. That’s a recipe for instant high bG. The way to keep that basal dribbling into the blood stream without causing a hypo is to use one of the more slowly absorbing basals. Ultratard will work, so will Lantus. A shot of Ultratard at 5 pm, and another at 10 pm will give you a basal dribble until late the next day. A shot of Lantus at 10 pm will give you a basal dribble until the evening of the next day, perhaps a bit later. Regards Old Al (A T1 who shoots 5 units Ultratard at 7 am, 5 units at 5 pm, and 6 units at 9 pm, all on the Western side of the Pond)
Response:
Thanks for the replies, they both give me some good ideas, not sure which my doctor will favour but they both can be considered. I will start on my diabetic specialist about changing the protaphane.
you’ll LOVE a change in your basal insulin, and find the ride a lot smoother than the old protaphane sh** ever is! good luck! k (UL 2x/day and Humalog)
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