My 15-year old son had had type 1 diabetes for 4 years. He has frequent episodes of both hyperglycemia and hypoglycemia. He is scheduled to have his deviated septum fixed and I want to know if he faces any additional risks because of his type 1 diabetes and if he should be doing anything differently with his insulin intake prior to surgery.
Surgery and diabetes can be tricky. If you have a pediatric diabetes team, I would suggest asking for specific information related to your son.
Surgery in people with diabetes should be conducted first thing in the morning.
- would suggest blood sugar be on the higher side prior to surgery: 150-200 mg/dl
- would suggest checking blood sugars before, during and after surgery with the availability of IV dextrose, if needed.
Anesthesia should be asking the questions below
- What kind of insulin regimen is he on?
If pump: basal rate should be continued, but if surgery first thing in the am- he will not need to bolus unless he is very high as he won't be eating. If on multiple daily doses of long acting insulin such as glargine, detemir, degludec etc. and rapid acting insulin such as Humalog, novolog, apidra, would suggest giving long acting insulin as usual (night for example) and if his fasting blood sugars have been at target range or lower, would lower long acting insulin dose by 2-3 units. If he is or has been high in the am, would suggest giving 1/2 correction to avoid lows.
Once again, you should consult your diabetes team as they know your child best and may provide more specific information in relationship to your son.
Fran R. Cogen, MD, CDE