# Positives about sliding scale



## SB2015 (Jan 8, 2016)

I am about to have a fairly long operation and I am likely to be out of it for a while so I will be put on a sliding scale (VRIII). I have read a lot of negative experiences about this, but does anyone have any positive experiences.

I have already contacted my consultant and we will have a planned set of criteria for return to self management post op.  I shall make sure that my husband know these as well. Once I am able to meet the criteria (eating, conscious, able to manage the pump) I can be returned to the pump

My diabetes consultant  has taken time to explain how the VRIII is managed and I can understand why an anaesthetist might want to use this instead of keeping me on my pump.  I have checked through the hospital protocol for VRIII and it seems to make sense.  The crunch seems to be when you return to a ward post op.  So long as they reconnect the VRIII on return to the ward and then check hourly it seems to be okay.  Once eating I should be able to get back onto my pump, following  the agreed criteria.


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## AlisonM (Jan 8, 2016)

Sorry SB2015, all my experiences of the sliding scale have been horrendous and, I've more than once had to phone my consultant from my hospital bed to come and rescue me. One of the main issues, every time, has been that regular checks are not carried out and testing has been missed as well. In addition, when I've tried to point out that there's a problem, I've been ignored, which is why I ended up calling my consultant - luckily for me, he's at the same hospital. This has happened repeatedly to the extent that I dread going into hospital and if conscious, won't let them put me on the d****d thing.


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## trophywench (Jan 8, 2016)

I've had 2 ops attached to sliding scales in the past, and my control was kept excellent for both.  First was for 24 hours, second was nearly a week!

What I should do is actually ask to discuss it with whoever's in charge of the nursing staff on the ward when you arrive on it - and say you want to check with her that hourly checks WILL be done, according to the Care Plan you agreed with the consultant, because you've heard so many horror stories.

There are opportunities for your nearest and dearest here you know even if you are still out of it - your husband visits you.  He stays for MORE than an hour.  Have you had your obs done while he was there?  If not, he needs to go and find out WHY.  Then he can ask the HCA who does the obs to see what they've been and ask her what she's been told they are supposed to be and at what point she'd ask a qualified person to check.

I have to say - my husband isn't diabetic but he recently had an op, and on the ward they did do his obs every hour.


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## Pumper_Sue (Jan 9, 2016)

What you need to do is make sure you have your blood sugar near you at all times and if not happy with numbers make sure they change the scale. I did this when I had a 5 hour op about 7 years ago. Each time they pumped me full of steroids I ended up going massively high so I suggested that they altered the delivery rate of insulin before the steroids were pumped in and all was fine.


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## SB2015 (Jan 9, 2016)

Thanks you so much Sue and Jenny

That is the first positive information about VRIII I have had, and with such good practical suggestions.
I certainly had no problems withi being allowed to manage my own diabetes when admitted as an emergency and I am hopeful that with appropriate questions and interventions by my husband all will be well with the op.

It is difficult to let go of the control that I have worked so hard to achieve with my Diabetes.  I had my husband put my cannula in this morning just in case he needs to after the op.  All went well.

Thanks again.


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## SB2015 (Jan 9, 2016)

... And Jenny did you turn your pump off and take out the battery when you disconnected?
I know that if i put it in stop it will beep at the ward staff and I don't want them trying a few buttons to see if they can sort it out.  For swimm/shower etc I just leave it running but that may not be sensible for a long op.


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## Pumper_Sue (Jan 9, 2016)

SB2015 said:


> Thanks you so much Sue and Jenny
> 
> That is the first positive information about VRIII I have had, and with such good practical suggestions.
> I certainly had no problems withi being allowed to manage my own diabetes when admitted as an emergency and I am hopeful that with appropriate questions and interventions by my husband all will be well with the op.
> ...


Just make sure the staff on the ward do not get to over enthusiastic and want to rip out your pump if hypo  That is what a nurse asked/said to me after I had had surgery, said didn't want to know anything about the pump except where to pull it out if hypo.

I had gone in prepared and took basic info in about the pump and what not to do. Basic instruction was do not touch my pump


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## trophywench (Jan 9, 2016)

Either take the battery out OR set it at 0% basal for however long.  You'll have to prime the tubing anyway when you reattach it.  And my husband has to put my cannula in quite often, as I have to use my backside, having run out of many suitable areas on the frontside!

Men seem to enjoy stabbing us far more than we ever do !


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## Maryanne29 (Jan 10, 2016)

I had a bad experience with a sliding scale while out for hours during heart surgery and recovery. When I looked at my notes (end of bed ones) hardly any BG tests had been done and I was far too high most of the time. This probably contributed to the infection I caught. I'd speak to the pump team and see if they can ke


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## trophywench (Jan 10, 2016)

... or the high BGs may have been caused by the infection Maryanne - if it was only waiting there brewing - of course the scale rates wouldn't allow for it - but OTOH if they did the blood tests and they were not within the range specific by the prescribing doctor - then they should defo have been referred either to him or to the diabetes consultant on call.


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## Pumper_Sue (Jan 10, 2016)

Whilst having surgery the anaesthetist will want to keep blood sugars a tad higher apparently hypo is the main problem during surgery. I was asked to reduce my basal a tad when I had surgery last year to make sure no problems.


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## SB2015 (Jan 11, 2016)

I have already asked if I could stay on my pump but they have said that for such a long op they will want VRIII.
My pump consultant can understand their point as they have not had many using pumps in this position so the anaesthetists are not so familiar with them, and it is better to be in the hands of someone who is confident with what he/she is doing. 
In the light of that, the ideas and checks from here have been so useful and I have much clearer plans for what to ask and what to do.  Thank you so much.


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## Northerner (Jan 11, 2016)

I have nothing useful to add, just wanted to wish you well for the operation - I hope everything goes smoothly and you have a swift recovery


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## SB2015 (Feb 3, 2016)

All ready for op next week.

- The amazing diabetes team at the hospital have promised to come up on my return to the ward.
- The op involves an X-ray during it so not a good plan to fry my pump, so VRIII makes even more sense
- Anaesthetist has phoned to reassure me about what checks they do during the op
- My husband is going to be there to make sure that BG has been checked hourly  
   and will have a spare test kit with him to test if I don't feel able to move easily soon after op.

Your advice was so helpful in my being proactive about putting strategies in place to addressing the issues raised.  I feel a lot more confident about it all.

I know that I will need to find an appropriate TBR once I am back on the pump, and no idea yet how high that will be, but it will be test, test, test.  Any ideas on what impact morphine has on BG?

Thanks again


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## trophywench (Feb 3, 2016)

I don't think that morphine has a direct effect on insulin requirements at all.

It only relieves pain and that bit of the mental stress we get because we're in pain - the actual shock/trauma to your body will be unaltered and the body will still produce the cortisol needed to enable it to fight that trauma and the injuries suffered - so the BG will still increase in the same way that it would anyway.


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## SB2015 (Feb 3, 2016)

Thanks Jenny

The wait is getting shorter.
I shall be glad when it is all over.


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## Pumper_Sue (Feb 3, 2016)

Morphine might make you very sick so anti sickness meds will be available as well for you. I don't remember morphine affecting my blood sugars actual pain does though.
Don't stress about having spot on bloods after any op as it wont happen.  I'm sure you will be just fine and it sounds as if corners have been covered. Even though you wont need it, good luck with your op.


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## SB2015 (Feb 11, 2016)

My operation went very well.

The anaesthetist preferred me to go onVRIII so I went with that.
Before the op 6.5 , during the op 6.8, in recovery 5.8, back on the ward 6.2.
I call that amazing, and the anaesthetist rightly proud of himself.

Now on a TBR of 210% and staying lower than 10 so far.


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## Northerner (Feb 11, 2016)

SB2015 said:


> My operation went very well.
> 
> The anaesthetist preferred me to go onVRIII so I went with that.
> Before the op 6.5 , during the op 6.8, in recovery 5.8, back on the ward 6.2.
> ...


Fabulous news! So pleased to hear that everything went so well  I hope you have a full and speedy recovery!


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## trophywench (Feb 11, 2016)

Great!

210% - just shows you the effects on your body, doesn't it?  Quite scary ......


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## grovesy (Feb 11, 2016)

Glad the op went well.


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## AlisonM (Feb 11, 2016)

Great news @SB2015. It's wonderful to hear the surgery went well. Here's to a fast recovery and a quick escape from the hostilepile.


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## Pumper_Sue (Feb 11, 2016)

SB2015 said:


> My operation went very well.
> 
> The anaesthetist preferred me to go onVRIII so I went with that.
> Before the op 6.5 , during the op 6.8, in recovery 5.8, back on the ward 6.2.
> ...


Fantastic very pleased all went well for you.


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## SB2015 (Feb 11, 2016)

I too have been surprised by how much extra insulin I am needing.  But instead of worrying about it I am going with the flow.  I suspect the variety of painkillers I am on are having animpact as well as the pain.

Lots of sleeping as well as the exercises I have been given to do and things are improving.


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