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Pre-PET insulin pump info needed

DEAR DR. ROACH: My wife is a Type 1 diabetic. She uses an insulin pump to control her sugar. She needs to have a PET scan. The prep for this test is fasting for six hours prior, along with no insulin for six hours. She was told to turn off her pump. Her blood glucose must be 150 or lower for the test. Even when she has fasted for 12 hours and her blood glucose is at 116, with her pump off, two hours later her BG is over 200. How do we get this test? — S.L.H.

ANSWER: An insulin pump is a programmable device that continuously injects a variable amount of insulin just below the skin, where it quickly enters the bloodstream. It most often is used by Type 1 diabetics, where it is often the most effective way of managing blood sugars, especially in people who have had trouble controlling their sugars with other means.

The insulin used in an insulin pump normally is very short-acting, so a few minutes after the pump is shut off, the blood sugar will start to rise. Since that is extremely dangerous in people with Type 1 diabetes, I would suggest a dose of longer-acting subcutaneous insulin before the pump is turned off.

Insulin pumps are prescribed and administered only by experts, and that almost always means endocrinologists, who specialize in diabetes. Thus, only her endocrinologist should be the one giving orders on the insulin pump and on subcutaneous injections (if her diabetologist agrees with me).

A PET scan is used to find areas of high metabolic activity, usually in people with suspected cancer. A radioactive analogue of sugar, usually fluorodeoxyglucose, is injected and will be taken up by cells that use a lot of sugar, which includes most cancer cells. A person needs to be very still after the injection, or the muscles will take up the FDG, which may confuse the results. However, the cells are less likely to take up FDG in people with high blood sugar, which is why the blood sugar needs to be well-controlled.

DEAR DR. ROACH: Recently I read about a woman who wrote about her “total” hysterectomy. There is a common misunderstanding that if someone has a “total” hysterectomy, that includes the ovaries and/or tubes being removed as well. The word “hysterectomy” refers only to the uterus being removed. If someone has tubes removed, it is a salpingectomy; if she has ovaries removed, it is an oopherectomy. A total hysterectomy therefore really would mean the entire uterus (and only the uterus) being removed. Occasionally women do undergo a “partial” hysterectomy, but is more accurately called a supracervical hysterectomy (meaning, only the cervix part of the uterus remains). It is important for women to know exactly what was removed. — Dr. Allison Duncan

ANSWER: I agree a patient should know exactly what operation was done. It has serious implications on subsequent risk of diseases, including breast cancer and osteoporosis, as well as the effect on cervical and ovarian cancers.

(Roach is a columnist for the North American Press Syndicate. Write to him at 628 Virginia Drive, Orlando, FL 32803.)

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