Surgery, Blood Sugar and Travel Analogy

I arrived at the hospital at 8:00 a.m. yesterday with Jess, a backpack, and a stomach full of butterflies.  The hospital has a metal detector at the entrance.  As Jess went through it she said, “This is like going to the airport.”

I went through a check-in process (airport analogy again) and then Jess and I began to look for the surgery area.  Somewhere along the way we took a wrong turn.  We ended up in a staff-only section where a dozen surgeons in green scrubs were having a meeting.  “This is not really like the airport,” Jess said.

At around 9:00, after finally getting to the right place, I met with the admitting nurse. She asked me a bunch of questions about my health and checked my blood sugar. It was 124.

I was sent to the waiting room until the surgery prep. Jess and I waited together, nervously, for 45 minutes.  As lovely as my wife is, she is not the person to take with you if you’re looking for someone comforting and reassuring.  Jess noticed every hair on the floor, potential health hazards where there were none, and repeatedly asked me to check my blood sugar. She also noted that the monitors with updates about exactly where each patient was – waiting area, surgery prep, in surgery, in recovery, in a room – were a lot like flight status updates.

Finally, I received a call on my cell to come in for surgery – a return to the area Jess and I had stumbled into earlier. I gave Jess a kiss and walked in. I got a robe to change into and was given an IV. I met with the nurses and anesthesiologist. I told them I have type 1 diabetes and showed them my pump.

I had my blood sugar checked before being wheeled into the operating room. It was a little higher, but still fine – 136.  I sent that information by mental text message to Jess.  She claims she never got it.

When I got to the operating room the surgeon was there waiting and after he said hello and asked me a few questions the whole team went to work strapping me in. One of the nurses reinforced my infusion set with tape (it really hurt to remove the tape) and hooked the pump up to some tape. Then the anesthesiologist told me to relax, injected something into my IV and put the mask on my face.

The next thing I remember is waking up in the recovery room.  I woke up feeling a little dazed, but fine. I looked at my pump (which I call my pocket-watch on occasion) – it was 12:00 p.m. I had been out for exactly an hour. A nurse came over and asked me how I felt.

“Fine” I said.

“Do you need anything for the pain?” he asked

“No. I’m fine,” I said.

I didn’t feel much pain at all and remembered that pain medication has a negative impact on blood sugar.

A few minutes later Jess was allowed in. I remember that she brought me my glucometer. I checked my blood sugar right away – 140. I was impressed with my well-behaved BG and happy all the predictions of crazy numbers did not come true. (Jess claims I hallucinated.  She did not bring me my glucometer.  She said I was holding a tissue on my finger when she walked in.  Apparently the first thing I said was “take a picture”.  Then I announced that my blood sugar was 140.)

From the recovery room I was taken to a regular room where I rested, watched TV and had a cup of coffee Jessica bought for me.  Jess entertained me by continuing the air travel analogy.  In surgery I was totally out of control, just like in an airplane.  Your life is totally in someone else’s hands.  And in the hospital I was confined to a small space with a small TV screen in front of me (although much larger than a seat on coach).  Jess took my order for coffee, but before she left for the café downstairs she asked the nurse if I was allowed to drink at all.  The answer was not yet and that I had to start with water, not coffee.  Seriously? 

Jess went home to the boys, and after a couple hours of watching TV and resting I decided I had had it and asked if I had to spend the night or if I could go home. The nurse told me that when the doctor was done with his surgeries for the day he’d come up and decide. I tried to relax and checked my blood sugar again. It was 168. I took a little correction bolus and went back to reading.

At around 4:00 p.m. the surgeon came in and asked how I was doing. I told him I felt fine under the circumstances and asked if I could go home. He told me it was up to me. As far as he was concerned I could go running tomorrow.

“Whatever the pain allows,” he said. “You can expect some puffiness and bruising, but anything more than that give me a call or go to your doctor.”

I called home and asked to get picked up. I told the nurse I was going and went to check myself out of the hospital. By the time my mother arrived I was outside waiting with another cup of coffee in my hand.

By dinnertime I was starving. I hadn’t eaten for 20 hours. I checked my blood sugar. It was 189. That’s weird, I thought. I bolused for dinner, taking into account that I would eat a lot. Before getting into bed I checked my blood sugar again it was 298! I couldn’t believe it. I was in pain and wanted to sleep but decided to watch TV and wait for my blood sugar to come down.

It didn’t. An hour and a half later it was 289.

I decided to try a new infusion set, thinking maybe something happened during surgery.  In pain, I walked to the study and put in the new set. I bloused and set an alarm to wake up an hour and a half later.

Before I fell asleep Jess gave me the present she’d been saving for my birthday. She came out with a pair of New Balance 993’s she had custom ordered for me. She had them stich T1D on the heel of one of the shoes and 42.2 on the other (that’s kilometers for 26.2). I was a little too uncomfortable to truly appreciate it.  But the message – of supporting me to get back on my feet and run – was a strong one.

I woke up before my alarm. The discomfort from the surgery had turned into full blown pain. I couldn’t sleep. I checked my blood sugar again – 244 – and bloused again. I got up to go to the bathroom. It was so painful and difficult. I started to regret the fact that I’d told the doctor I didn’t need a prescription for painkillers. Suddenly, while dragging myself, I thought of how Jessica after her c-sections, which are way more serious than my surgery, dealt with her pain while nursing and caring for a newborn baby. Wow, I thought to myself she is amazing, she didn’t complain much – or at least I don’t remember.

I dozed off for a little while and woke up around 3:00 a.m. I was so uncomfortable and in so much pain that I couldn’t sleep. (I usually sleep on my side and can’t now.  Difficult to sleep, much like on an airplane.) I checked my blood sugar again it was 200. At least it was in the right direction. I bloused again. I watched a movie and then surfed the many channels with nothing to watch. At around 6:00 a.m. I dozed off again, minutes before Adam arrived to cheerfully greet me and request to watch Dora and Diego in my bed. I woke up at 8:00 a.m and my blood sugar was 168. Again, I bloused. So much for well-behaved BG I’d been so proud of during the time of the surgery.  

Apparently pain, not just pain mediation, negatively affects blood sugar.

Michael Aviad

Michael Aviad is co-founder of ASweetLife. He was diagnosed with type 1 diabetes in 2002. Michael was born in Santa Barbara and grew up in Jerusalem. He studied law and after passing his bar exam went on to get an MBA with a major in finance. Michael worked for many years as an economist. He and his wife Jess, also a type 1 diabetic, have three sons. Michael loves to run and is always training for the next marathon.

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