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Question:

From Staten Island, New York, USA:

Our six year old daughter has had type 1 diabetes since age four. Her blood sugar levels are generally well controlled and she is on a MiniMed insulin pump. She uses Humalog. Her ENT (Ear, Nose and Throat) wants her tonsils and adenoids out since they are enlarged and interfering with her breathing and eating. What impact will her diabetes have on her healing time? Will it take longer for her to heal since she is a type 1? Will her blood sugar levels rise for a while after the operation?

Answer:

I would imagine that children with type 1 should heal just as well as children with no diabetes. Some caveats to consider:

  1. Make sure you have good indications to have the tonsils removed (not just because they are enlarged - "just because they are big does not mean they are broken". My indications are a) obstructive sleep apnea diagnosed by sleep test or b) recurrent/chronic tonsil infections.

  2. Removing tonsils will cause pain and will definitely impact on oral intake. Adjust insulin requirements accordingly.

  3. The stress of the surgery can cause an increase in stress hormones, which could increase the blood glucose.

  4. On my non diabetic patients, I would use steroids to help decrease inflammation/pain. I would not use this in children with diabetes.

  5. I use "cold ablation"/coblator techniques - this is much less painful than standard/older techniques, which are more painful (see AthroCare ENT). My total surgery time is usually less than 20 minutes with no blood loss.

  6. Make sure the anesthesiologist knows how to deal with diabetes. I have heard anesthesiologists giving patients extra insulin prior to surgery based on pre-admission testing done several days before surgery (aka - does not have a clue).

  7. I would recommend you have your child stay overnight, at least one day, so glucoses can be monitored closely and adjusted accordingly, which would help with healing.

  8. Your child should be the first patient of the morning to avoid needing to be without eating for such a long time.

Please let us know how your child does.

PSL

DTQ-20050830113844
Original posting 13 Sep 2005
Posted to Other

  
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Last Updated: Tuesday April 06, 2010 15:10:04
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