A Tale of Two Docs (in which One gets it Right)

A few years ago, I had an appendectomy at my local hospital. It was a smooth experience all around, in and out of the ER/Hospital in less than 24 hours, with decent blood sugars considering the stress, pain, and infection. I raved about the experience, and noted that the only less-then-perfect part was the anesthesiologist who was, if I may speak frankly, something of an ass.

I remember lying on the bed in the pre-op area discussing my blood sugars. I pointed out that they had held steady throughout the afternoon but were trending higher. What I wanted to say was, "I know my numbers are high - I've been worried about going low while not being able to eat. I think I should take more insulin, but since I can't eat, I can't treat a low, so what should I do?" What I got out was, "I know my numbers are high..." before the doc standing over me cut me off with, "they're too high. We'll manage it from here."

Now, I'd like to think I'm the kind of person who could stand up to that, and maybe I am when morphine's not involved, but this was a guy who was about to be in total control of everything about me for a few hours. Asshole or not, I didn't want to piss him off.

They managed me well enough through surgery - one +300 excursion was addressed with a bolus (they kept my pump on). In hindsight I would have asked about a temp basal rate to keep that 300 from happening, but it all worked out.

Last week, I underwent surgery again, this time in Richmond (because, funny enough, the local docs prefer not to operate on type 1's. Well, at least they know their limits.) This time, I had plenty of notice, so I had stopped eating the night before for a 2:15 PM surgery. That, my friends, is what I like to call an excellent opportunity to test basal rates!

Long about noon I realized that my mid-day basals are a little too high (lazy way of covering snacking!). So I decided on a 70% temp basal rate and coasted through the pre-op steps with blood sugars in the 115-120 range.

After the (fantastic) nurse was done getting me ready, I met with the anesthesiologist. She sat down, reviewed my chart and asked me how my blood sugars were running. I told her about the 140 - 160 range of the night before, and my success with a 70% basal rate throughout the late morning/early afternoon.

Then, dear reader, she won my heart (or at least my non-functioning pancreas) by saying, "We can go with IV insulin, but we like to have our type 1's keep their pumps on if possible. How confident are you in that basal rate?"

I said, "let me check my blood sugar once again. It's been an hour since the last check - if I'm still in the 120 range, I think we're good to go."

She agreed. I was 118. I showed her and the nurse anesthetists how to wake the pump up and shut it down if needed. Pump remained on through the 2 hour procedure. With the exception of a few hours overnight, when my numbers inched up as high as 250, I coasted through the next 24 hours with mid-100's.

But it's not the numbers that thrill me, so much. It's the doc. Sitting down, asking me how I was managing my diabetes, asking me if I wanted to keep my pump on or switch to IV insulin. Asking me.

It shouldn't be so shocking, a physician consulting the person who's had the disease for 23 years. And it's not the first time it has happened. But it is so remarkably nice when it does happen, don't you think?

PS: I'm recovering very well and enjoying great blood sugars. I don't know if the better numbers reflect the lack of stress now that my health issue has been resolved, or the fact that I have all the time in the world to check blood sugars and look up carb counts. Whatever it is, I'll take it!

PPS: For those in the area, I highly recommend Johnston Willis Hospital. Excellent care and wonderful people, from start to finish.