My mother has type 2 diabetes and is likely to need an operation later this year. The part that worries me most is not the surgery itself but how the blood sugar is handled around it, because her numbers swing a lot when she is stressed or not eating normally. For those who have been through surgery with diabetes, how much did the team adjust things beforehand, and was there anything you did in the weeks before that made a difference?
Hi there. I have type 2 diabetes. At the time of my treatment I was on Metformin, Empagliflozin and Trulicity injections and was well controlled. I had chemotherapy and then surgery. I spoke to my GP nurse practitioner, who looks after my diabetes, before starting chemo. She said to test twice a day - I already had a testing machine. I wrote down all the results. During chemo the steroids caused my blood sugars to go very high for a few days and then righted itself after about a week. The nurse said to sit it out and provided it reverted to normal after a few days and I felt ok then it was ok. Obviouslyif your mother isn’t having chemo this won’t be relevant for her. I had a lumpectomy and axillary clearance. The nurses tested my blood sugars prior to and after surgery. I tested twice a day prior to admission and ate as normal. I was told to miss out my Empagliflozin for 3 days prior to surgery. The Metformin was to be taken normally except for the day of surgery as I was nil by mouth. Post op I restarted the tablets the next morning and did my blood sugars twice a day during my recovery and they remained within normal limits.
Obviously it depends on what treatment your mother is on for her diabetes and whether she usually has symptoms.
I would suggest your first port of call would be to the person who oversees her diabetes care and to see what they suggest. It may be worth asking if they can provide a blood sugar monitor on a short term basis, or to consider buying one. Keep her diet the same as it usually it. Make sure that everyone knows she is a diabetic. I had a pre op check about a week prior to the surgery and they went through what tablets to take and when.
Basically the surgery had little effect on my diabetes and I hope this is the same for your mother. Speak to the person overseeing her diabetes. The surgical/oncology team had minimal input in the diabetes care.
Dear @tressabcn2, I have type 1 diabetes. The person who was responsible for managing my blood glucose during my surgery was the anaesthetist so Im sure this will be the same for your Mum. I checked my blood sugar before the operation and also afterwards. The anaesthetist checked it during the operation.
Ensure the team know know that your Mum has type 2 diabetes and what medication she is taking. I took all my meds into the hospital with me in a bright orange medical bag that I got from the Diabetes UK online shop and labelled this clearly with my name, nhs number, and hospital number.
The Diabetes UK forum is another useful place for asking advice of other people who may have had surgery with type 2 diabetes on similar meds.
Sending best wishes to you Mum, love Tulip x
I have seen people given very different targets for control before an operation. What have you been told, and did it match what you expected?
The Empagliflozin being stopped three days before is the detail I would write down and take to the anaesthetist, because that is the one class of tablet that gets held around surgery rather than the Metformin, and it is held for a reason that has nothing to do with blood sugar being too high.
What also comes through is how much of this was already decided before the operation. Testing twice a day, writing the numbers down, keeping the diet the same, all of it happened in the weeks before rather than on the day. That is the part a stressed body cannot do for itself, and it is why having the person who runs the diabetes care involved early matters more than anything decided in theatre.
You mentioned the steroids pushing the numbers up for a few days and then settling on their own. Did anyone give you a number at which you were supposed to call rather than sit it out, or was it left to how you felt?
The nurse said if I felt ill, if it stayed raised for more than about a week, or went very high. It was scarily high for me but I phoned her and she said so long as it reduced each day, and I felt well and it was back to normal after a week at the most, then it was ok.
There was a pharmacist at my preop appointment who went through all my tablets and gave me a printout of what to take when and what to stop when. Very useful. Obviously this may be different at different hospitals but she will have a pre op check of some sort I’d imagine
Tulip, the orange bag with the name, NHS number and hospital number on it is the single most useful thing in this thread. Everyone is told to bring the medication, and almost nobody is told that the labelling is what stops it being given twice or not at all.
The anaesthetist owning the glucose during the operation is the other part worth repeating, because it answers the question most people arrive with, which is who is actually watching it while you are not able to.
Does the team tell you in advance that the anaesthetist is the one who manages it, or did you find that out on the day?
I asked my treatment team in advance of the surgery who would be monitoring by blood sugar. My situation was different as I am type 1 insulin dependent but the management of my diabetes was uppermost in my mind throughout my treatment. I’m glad to hear the pharmacist was helpful with clear advice regarding your Mums medication.
Asking in advance is the part that changes it, because it means you arrived knowing the anaesthetist owned the glucose rather than finding out on the day. Type 1 makes that more pressing, not less - the insulin is already in your hands and the operation is the one stretch where it is not.
What I would take from your post is the same thing you said to me: tell them before, not on the morning. The orange bag and the labelling are what make that work when the team changes shifts, and that is the part a person can actually control from their side of it.
You said the management of it was uppermost in your mind throughout the treatment. Was that because of something specific that had gone wrong before, or was it simply how you were taught to think about it?
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Hi tressabcn2,
Thanks for posting. Apologies again for the delay in replying.
It looks as if you have had some helpful responses from @pat and @Tulip29.
Your mum (or you with her permission) can speak to who manages her diabetes about this as mentioned. They can develop a plan around managing her medication and monitoring her blood sugar levels depending on her individual situation.
@Tulip29 signposts to Diabetes UK. They have information about managing diabetes in someone who is undergoing surgery. There is often a multidisciplinary approach to managing this including the anaesthetist, surgical team and person who manages the diabetes.
Before surgery it is usual to attend a pre-assessment clinic where your mum can discuss her diabetic medication and ask any questions. You may want to download or order our booklet Your operation and recovery.
We have a service called Someone Like Me where we might be able to match your mum to someone who was also diabetic and had breast surgery.
We also offer a range of other free supportive services which you both may be interested in. They include face to face and online courses and events.
As we lock this thread once we have replied you may want to continue the conversation in the surgery section of the forums.
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