Postop patients using DAFNE

I am the Diabetes Link Nurse on my ward and was wondering whether there is any info with regards to managing a patient postoperatively???? Do we still manage them as we would patients who are on a 'twice daily' insulin regime postoperatively? What about DAFNE patients who have to be started on an insulin sliding scale post op, is the protocol the same when restarting them back on their regime??? I have looked every where and can't seem to find anything.


I am a diabetic myself using the DAFNE regime and have looked through the info that i was given but haven't found anything.

I am trying to put information together to help educate my collegues on the ward, some of which hadn't heard of the DAFNE course until a patient was admitted using this regime?

Any help and advice would be greatfully received

My understanding of the sliding scale is that it is basically like a pump except IV. With monitoring of BGs every hour or two..............so for me any patient on this, whether they are on a mixed insulin regime or MDI have to be treated the same way.

A DAFNE patient will probably be more suited to a sliding scale as they will know what there insulin/carb ratios are, which in my opinion is essential information when on the sliding scale. A pumper would be even more suited as this has many similarities in the fact there is a continuous supply of insulin and also the option to correct a BG at any time.

A mixed insulin patient would not be aware of any insulin/carb ratios so may find themselves going high after meals, but fortunately checks are made every hour or two, so quick action can be taken.

So to conclude in my non professional opinion, I hope it helps, is that any patient regardless of regime will be getting the same accuracy of monitoring and blood glucose correction but the pumpers and DAFNE patients will be able to provide you and your colleagues with better information regarding there insulin/carb ratios, dose times etc making your job much more successful in terms of their control.

I babbled on a bit their, I apologize if I went off topic.........

If the patient is not on an IV supply then I think treatment is limited to the regime..........if a mixed 2 a day regime, you could test their BGs as much as you want, but you wont be able to do much if they are spiking or going high, or will you...?

If a DAFNE patient, they should have the information to help you do the job effectively, and as you also have DAFNE training, it should be no problem, teaching the other nurses may be a pain right enough......

I hope I didn't talk nonsense there........

Hi Larissa,

Just a quick note - I was put on a sliding scale when I was pregant with my son. He was born early and they needed to give me steriods to develop his lungs for an early c-section.

They told me that my insulin would be delivered by the scale and that I should stop both my BI and QA for the time that I was on the drip but that I should continue to eat normally. At the time I thought that this was strange as surely this would only work if you're not eating. Otherwise you're expecting a BI to regulate CPs which I didn't think that it would be able to do.

Sure enough, I became very ill for the 24 hours that I was on the drip, my sugar levels shot up and couldn't be brought down again for a while. I got sick and dehydrated and really worried about the health of my baby.

When the diabetes team came to see me they said that I would probably have managed better without the sliding scale, regulating my own insulin or that, as I was eating normally, I should have carried on taking my usual ratios of QA with meals and just cut out the BI. This is more what I thought at the time and I should probably have insisted on it but you trust that people know what they're doing don't you, especially when you're not yourself.

If I was in the same position again I would definitely be really wary about using a sliding scale.

I think that there are still issues with people in the medical profession not really understanding DAFNE. I appreciate that not everyone can be DAFNE trained but personally I really think that anyone likely to be working with diabetes should have a short briefing in the basic principles.

Let me know what you think as someone who works in that area.

Melissa

Hi Melissa,

Thank you for your response

I agree that DAFNE isn't fully understood by people in the medical and healthcare profession and that everyone working with diabetes should be aware of the basic priniciples of DAFNE. Which is why I have been assigned to find information to enable my colleagues to be more aware about Type 1 diabetes and patients using DAFNE, who are admitted to our ward.

I can understand in your situation, that you would have managed better without the insulin sliding scale. Like you say, we expect people looking after us to know what they're doing, so i hope that I can help educate people and make them more 'DAFNE aware' with my experience and also with information i have received from other diabetics like yourself .

Larissa

Hi Larissa,

It's really encouraging to hear that you've been appointed in a role like this as I think it's so important and I'm glad that your hospital or health trust appreciates that. I'm also a little bit jealous as I would love to do something like that!

Good luck with what you're doing and I hope that it all goes well.

Melissa