Archives for July 2017

Tonsils, Tubes and T1D

Last week, Isa spent a night in the hospital after what is normally a routine surgery — tubes, tonsils & adenoids removed. Isa’s surgery went well and her recovery was very quick; in fact, it was much quicker than we expected. This was not her first surgery, but it’s always a bit unnerving when your child is given anesthesia — especially if that child has type 1 diabetes.

In addition to an enormous amount of love and support (thank you!), we received a lot of questions from people asking what to expect when their type 1 child has a similar procedure. So, here are our thoughts and advice based on our experience…

First, we had a pre-op appointment with Isa’s endocrinologist and pediatrician a few weeks before the surgery. The pre-op appointment is likely to happen automatically but, if it’s not required, you might want to consider scheduling one to limit surprises on the big day. This was a great opportunity to ask questions and also document some of our requests.

For example, we wanted her to keep her OmniPod insulin pump on during surgery. During her last surgery we discovered that some surgeons may want to take your child’s pump off. It’s important that you voice your opinions on whether or not your child keeps their pump on and be prepared to help figure out the plan for pump management during the surgery if they’ll keep it on. Same thing goes for those wearing a continuous glucose monitor like a Dexcom.

The morning of the surgery everything happens pretty quickly after getting checked in. Therefore, it can be a little overwhelming and hard to remember all of your questions. So, we’d suggest preparing some questions in advance. Here are some questions and things to consider:

  • Push for a morning check in and surgery time since your child will have to fast. Best to fast overnight and in the morning rather than all day long. Tip: Isa wasn’t permitted to eat or drink after midnight the night before her surgery but they did say clear liquids, including apple juice, were allowed. This was good to know in case she had any lows during the fasting period.
  • Confirm whether or not your child will stay overnight following the surgery.
  • Confirm fasting plan prior to surgery. What happens if your child goes low overnight or in the morning before surgery? How can you treat the low? Will a liquid like apple juice be ok (see above)?
  • What will happen to the pump during surgery, if your child wears one? Is there someone who you will need to “train” on the pump prior to surgery? (Our surgical team did not do anything with Isa’s pump during surgery. They let her basal run and just monitored her blood sugar with her Dexcom and manual BG testing).
  • How will they monitor blood sugar during surgery? If your child has a CGM, will someone be watching the CGM or will they just do periodic checks? (The anesthesiologist took Isa’s iPhone that she uses for her Dexcom into the surgery and monitored it throughout.)
  • What happens if your child goes low or high during surgery? (Generally this is the responsibility of the anesthesiologist and they will be on top of it…but still helpful for you to know the plan.)
  • How long do they expect the surgery to last? (Isa’s lasted one hour but there is no standard time frame.)
  • What kinds of food should your child eat or not eat during recovery? For how long after surgery? (We discovered this really depends on how your child is doing post-surgery. Isa was ready for buttered noodles the night of her surgery! Some kiddos take a bit longer to heal and may be subsisting on popsicles and Go Go Squeez packets for a week.)
  • Bring something that is important and soothing to your child (favorite blanket, stuff animal, etc). This will be helpful for them before and after surgery and ensure they are as comfortable as possible.
  • Our hospital has Child Life Specialists who do a great job of explaining what will happen during surgery to the child. If your hospital has a similar role you should ask to have them visit your child before surgery (which may already be part of the plan).
  • For you: wear something warm. Hospitals are always cold, in our experience. Also, bring some things to keep you busy — you’ll be waiting around quite a bit before, during and after surgery.

While type 1 makes any procedure or surgery quite a bit more stressful (mostly for parents!), know that your child will be just fine. Trust that the medical team knows exactly what they’re doing and will take great care of your child. Remember that kids are resilient and T1D kids even more so.
-Greg