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Wednesday, 24 August 2016

Endoscopic Review

There are some rare perks to having Type 1 Diabetes. Being first-in-line for a medical procedure is one of them.

I recently had an endoscopy to check for coeliacs disease and when I first called up to book I was offered a mid-morning appointment. It wouldn't have suited my diabetes at all. I casually dropped the magic 'D' word into my next sentence and I could almost hear the scramble on the other side of the phone to come up with a better time. Within 10 seconds I had been bumped up in priority to the much coveted procedure prime-time at 6.40am.

In the weeks prior to my endoscopy I did all the necessary, glutening myself up and setting appointments with my educator and endo for proper management during the procedure. The nurse at the endoscopy clinic became my new best phone buddy, working through the procedure with me beforehand to make sure that they had a handle on my Type 1 and my insulin pump.

After 4 frustrating weeks of glutening myself, dealing with the pain that came after eating and the resulting hypos, I was cheering when the morning finally rolled around.

My husband dropped me off on his way to work and sat with me until it was time for the procedure. Despite being nervous I was doing well. It made it a lot easier knowing that I was first in and wouldn't have to wait for anything.

Shortly after arrival I was called in to an assessment area where I met the doctor performing the endoscopy and went through a medical check, where they tested BP, my BGL, weight and height, and the details of the last food and drink I had had. To get an endoscopy you fast for 6 or so hours prior, so having the first appointment of the day was really helpful. I had accidentally consumed 4 jellybeans at 3am when I woke up a little low, but they were fine with this. I was asked if I had any questions and the only thing I really cared about was that I would be put out to it as I had read that some people were awake during these procedures. I was assured that because I had ticked the anxiety box on my pre-admission forms that I wouldn't be aware of anything happening to me.

After the assessment I was led through to the op area and set up in a bed where a nurse attached a BP monitor, pulse oximeter and inserted a cannula into the inside of my elbow. I met the anesthetist who once again reassured me I would be out to it. The anesthetist was the one who was in charge of my diabetes during the op, so I took him through the management plan my educator had set up with me. I checked my blood sugar, which was on 12 and rising (which it does every morning until I eat breakfast) so I kept my basal rate on my pump as per normal. I showed the anesthetist where my pump canula was inserted on my hip and the CGM in my arm and taught him that to check my blood sugar he could simply press the middle button and my CGM reading would show up on the pump screen. He was happy to let me self-manage as it was such a short (20 mins max) procedure.

It was as I was explaining the CGM that a second nurse entered stage right to remark on my insulin pump.

"An insulin pump?" She remarked, "What do you need that for?" I thought the answer was pretty obvious but replied that it was to help manage my Type 1 Diabetes as an alternative to injections.
"Ohhhh, so you must have really bad diabetes then if you need that, hey. And you're so young."
The last thing I needed as I was getting ready for a procedure was aggravation like this. I bit my tongue and explained that the pump was just another means of insulin delivery, similar to needles but with less injections and more freedom. She turned her nose up and sniffed that she "would prefer injections, if you ask me, because no-one can see that you have diabetes that way."

I went to reply, but I think the anesthetist either noticed my BP rising or the daggers I was shooting this nurse, because before I could reply he had motioned the other nurse to place a round tube into my mouth and announced that he was going to be putting me out right now.

40 minutes later I was hazily opening my eyes in recovery, feeling lovely and relaxed, wondering how I could get my hands on some anesthesia for home use and trying to avoid the nurse seeing that I was awake so I could just lie there a little while longer. She did eventually notice that I was lying there with one eye crooked open and bustled over to see how I was doing. She checked my BG (which I could already see had remained stable on my CGM) and got me up to have a breakfast of ham sandwiches.

20 minutes later I was being released into my mums care with instructions that I should receive the biopsy results in a few weeks' time.

The procedure was a lot easier than I thought it would be and I was surprised at how well my BGL held steady without any temp basals. The staff were all lovely & professional (minus that one nurse) and the only thing I wish I had been told about before was that its quite common to have sternum pain for up to a week after the endoscopy.