My son is six years old and has had type 1 diabetes for about a year. He needs a tonsillectomy and the doctor is advising me to give him two-thirds of the NPH in the morning. Since he cannot eat possibly the whole day, is it still okay for him to have NPH in the morning?

It’s always a little difficult with minor surgery like this to anticipate exactly whether blood sugars will tend to rise because of the stress or fall because there is no food intake. For this reason, it is usual, assuming early morning surgery, to reduce the morning NPH to between one- half and two thirds of the normal dose. It is also usual to set up an intravenous line so that glucose can be added and to monitor blood glucose closely in case additional short-acting insulin is needed. It is always a good idea too if the surgeon and/or anesthesiologist can consult with the diabetes doctor beforehand. You yourself should keep the usual insulin, glucagon and testing materials on hand and be sure that you know how to contact the diabetes team for the journey home and subsequent recovery period.

DOB

[Editor’s comment: Also, see Surgery Pre-Op Advice (at the Diabetes Monitor) for some additional thoughts.

SS]