I am having surgery this upcoming week for complications with my colon. My internal medicine doctor said it should be fine to wear my insulin pump and CGM during surgery as it will provide better control throughout the procedure. I just need to drop my basal by 30% and show the doctor doing the surgery how to suspend the pump, if needed, and how to get my blood glucose readings off my MiniMed 722 pump. I am confident in his decision as I prefer tight control as well as my settings on my pump versus a predetermined dose by the hospital. Is this feasible or is it better just to go with hospital dosing? The surgery should only be about two hours according to the doctor. He said it is up to the anesthesiologist but the general surgeon said he see’s no problem with it as long as the sites of both the CGM and pump are not in the way of where the surgeon needs to make his incisions.

This is not an infrequent question. People who have an insulin pump have invested in their care and generally have good control. Wanting to have good control surrounding the surgery is a concern, especially when you are handing over the process to doctors you don’t know. However, there are technical issues that arise with the abdominal surgery and the insulin pump/sensor. First, I am concerned that insulin delivery might be different in the perioperative state because there may be local pressure applied to the infusion site as part of the surgery. This may change the insulin delivery during the surgery. There is also the additional issue of making sure the infusion site remains intact and continues to deliver. If the anesthesiologist is not going to monitor glucose levels frequently, this may not be picked up right away. I practice at a university teaching hospital. At our institution, if we have any question at all about the monitoring or satisfactory nature of the procedure and insulin therapy, we use an intravenous insulin infusion. This also has to be monitored at least hourly, but has the advantage of not having the infusion site affected by the manipulation of the abdominal wall at surgery.

In most cases, the anesthesiologist is responsible for monitoring glucose values around surgery. I would see if you can contact this person before surgery and talk this over. If the surgery is short, the anesthesiologist is comfortable with pumps, and glucose monitoring is frequent, the insulin pump can be tried. Special care should be made to place the infusion site at a location a day before surgery and out of the way of the incision site. If all of these issues cannot be worked out, you might want to have your insulin delivered by intravenous insulin. If you don’t know for sure, recruit the help of your doctor managing your insulin pump.

JTL