From Atlanta, Georgia, USA:
Our son is four years old and has been diabetic for three years. He will be having an endoscopic biopsy done next week to determine if he has celiac disease. He will be put under general anesthesia and the procedure will last about 45 minutes. This procedure will be done at 7:00 A.M. He will be given Versed prior.
Our questions are:
- How does the blood sugar respond to Versed and general anesthesia?
- Since we plan on trying to have him in the higher end of his target range that morning (180), in your experience is a small amount of N suitable for an am shot or would any shot be omitted?
His usual dose of insulin at 9:00 P.M. is 1 unit of N.
Celiac disease occurs in about 1% of children with Type 1 insulin dependant autoimmune type diabetes. It can be screened for by looking for anti transglutaminase antibodies in the serum. If these are found then the usual procedure is to perform a small bowel biopsy to look for changes that are typical of celiac syndrome. If these are present then current practise is to suggest a gluten-free diet. You do however say that your son become diabetic soon after birth. This raises the possibility that his diabetes is not autoimmune and that there might be another cause for the symptoms that led to this further evaluation. I expect that you have discussed all this already with his diabetic doctor.
Versed is a preoperative medication that has been extensively used in children: its action is very rapid and being water soluble it can be given under the tongue. There has been at least one study of its effect on blood sugar in this age group and it was found to be minimal. General anaesthesia however tends to make blood sugars rise.
There are several ways of managing blood sugars during a short surgical procedure such as this and the important thing is to make sure that your son's diabetes doctor talks to the anaesthesiologist and that they have an agreed plan, two essentials of which are to be prepared for unexpected delays and to have a system in place for prompt blood sugar measurement. Assuming that your son will go to the theater fasting the two commonest systems are either to give about half the usual morning dose of long acting insulin, to have an intravenous line in place through which glucose can be given and to give additional regular insulin intravenously or intramuscularly as indicated. The second method would be to control blood sugars entirely by the intravenous route until after the procedure.
Original posting 30 Mar 1998
Posted to Insulin
Last Updated: Tuesday April 06, 2010 15:08:58
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