Yesterday I had to visit the hospital to have a PICC line inserted because my ear infection is not responding to oral medication. The PICC line will be for the purpose of IV antibiotic treatment. Anyway…I was at a very large hospital at the ambulatory care center and as part of the admitting procedure they ask you if you have any implanted devices? When I said "I wear both the OmniPod and the Dexcom Glucose Monitor…you should have seen the surprise on a few faces. It was “what is that and where are they placed?” I mean this is a hospital after all and they had never seen either device. Makes me wonder what the heck would happen if I was admitted to the hospital for diabetic reasons. Insulin pumps have been around for a long time and the nurses don’t know what they look like nor how they operate??? Anyone else run into a similar situation???
A friend of mine is an ER nurse and mine was the first pod she had heard of or seen.
Hope your ear infection (ow!) is clearing up.
It is hard to teach an old dog new tricks. That is, at hospitals, especially if they do not have a special endocrinology wing (and often even when they DO) the practice (unfortunately) may still be to administer insulin with MDI for inpatients, and they may even use something as antiquated as a sliding scale (if your number is between x and y, give this much insulin. Above y, give this much more, etc). It is a little scary to think what kind of treatment or care that someone might receive if he or she entered the hospital and for whatever reason, was unable to make decisions regarding diabetes by themselves…I think it will just take more face time with individuals on pumps (and specifically on the pod) before it becomes a well-known item that is not looked at any differently than other treatment options…
I hope the antibiotics with the PICC help! Good luck and hope the infection clears soon!
I once had to threaten to leave a hospital ward twice in a 12 hour period AMA (against medical advice) because the ER doctor who admitted me wanted to use a standard sliding scale, and when my evening glucose was over 300, he wanted to “wait until morning” to let me have my normal dose of Lantus which I generally took in the evening. I told the nurse who was relaying his orders that I would be in a coma by morning, and that she either let me have my Lantus, or I was walking out of that place. I will NEVER go to that hospital again, even though it is the closest one to my home.
When I told my endocrinologist what had happened, she said that if I ever got into a situation like that again, to request that the doctor “consult” with her. She said another doctor would not call her in to treat me, but that if patients ask for a consultation, most doctors will agree to that. Now I know the magic word, and so does my husband so if I am not able to speak for myself, he can request a consultation on my behalf from my endo.
Educating others about the Pod depends on us, so keep spreading the word.
This is scary stuff. Here we are using a very sophisticated form of insulin management within the context of a medical system that’s pretty much out of touch with progress in their own field. Whenever we get the opportunity, we all have an obligation to try and educate medical professionals about the omnipod.Also, make sure that the person most likely to accompany you to a hospital if you are in an unaware state, is fully informed about your pod and how hospital staff should best administer insulin for you if it must be done by injection.
Yesterday, my CDE gave me this WONDERFUL form distributed by the ADA to carry with me to the hospital when I deliver my baby in a few months. It basically explains the insulin pump, instructs them NOT TO TOUCH IT, and says that I should retain full control of my blood sugar monitoring and pumping as long as I am conscious. If I am unable to do so, my husband has power of attorney to run my pump and test my BG.
I had a horrible experience in 2001 when I was 21 and had my appendix out. The nurses confiscated my pump and would not give it back and weren’t even treating me with the insulin I was on at the time (Humalog), opting for NPH and Regular. They were running my BGs post-op in the 300s to prevent hypos, even though I was begging for my pump and in complete control of my faculties. I finally had my mom call my endocrinologist. He wasn’t affiliated with their hospital, but drove over within the hour. He came in and demanded that they relinquish it. The nurses were so ticked, but they did as he instructed.
I will scan the form I got yesterday and make it available here on TuDiabetes in case you guys would like a copy for yourselves!
Thanks MelissaBL for sharing the form from your CDE, when you have time. I’ve often wondered how to acquire such a form for carrying in my wallet.
Thanks MelissaBL! I think letting everyone have a form like that is a great idea, not just for planned ventures to the hospital (having a baby) but also to keep around in case of unexpected situations. The group definitely appreciates it!
Here is a copy of the form.
6948-Hospital_Pump_Instructions.pdf (1.25 MB)
Again…Thank you MelissaBL
Thanks for posting this form!!
I have a question - I notice the form says that if the pump is disconnected, Regular insulin will need to be administered? Is Regular a word that just means “regular” or is it actually a type of insulin?
That bothered me, too. Yes, they mean “Regular” insulin, as in the “fast-acting” human recombinant insulin used between 1982 and the advent of Humalog/Novalog/etc.
That’s what they did to me in 2001 when they took my beautifully working Minimed full of Humalog away and put me on actual Regular, which I hadn’t been on in nearly 4 years. It did nothing to bring my sugars down. I think I will be making a note on my form when I’m admitted for my delivery that says they may administer from MY vial of Apidra to make sure that they are not giving me Regular. I plan to pack an extra vial of Apidra in my hospital bag just in case. My understanding is that Regular is what hospitals keep on hand though, so you’ll want to ask in the event that you’re ever admitted while conscious and functional. If you’re admitted in an emergency though (accident, etc), I’d understand them giving whatever they have to give. It has a much slower onset and longer tail than the fast-actings we use now, so I would have them give it as much as 45min to an hour before meals and to make sure they have you on a long-acting insulin in the background.
It also bothered me that it talked about how I “routinely test 4 times per day.” Yeah, years ago maybe. I wear a CGMS (that I’ll be instructing them not to touch as well - thinking of writing DO NOT REMOVE in sharpie around the tape!) and I still test twice that often.
Hospitals are absolutely the worse place to control your glucose levels.
Last time I went I took care of my diabetes myself. I wouldn’t let them
touch me, regarding my diabetes. I was just hoping my reservoir held out
till I was released, or else I would be doomed with high glucose levels.
This must be one disease that very few care about. When a nurse studies
in school to become a nurse, dont they learn about Diabetes and how it"s
treated, the same goes for those wonderful Interns who don’t have a clue how
to control one’s glucose level.
Did you ever wonder why certain medical personel know so little about such
a serious disease that effects so many of our population.
To play devil’s advocate for a moment though, in a hospital setting, there is a much higher incidence of death of patients due to hypos than elevated blood sugar levels. Study after study finds that by elevating blood sugars above normal control ranges, patients are kept “safer” while under the hospital’s care. Those of us used to nearer-to-normal control may be outraged (and trust me, I am), but we are a small subset of the diabetic population that they see.
Their thoughts are that, when we are released from their short-duration responsibility (and liability), we can manage our condition as we see fit. They can’t be expected to administer faster insulins to someone who may never have had them before. Nor can they expect/afford to keep fresh, unexpired vials of every major insulin on the market in their fridge. That’s why I believe it is OUR responsibility to keep information (like that form, or a birth plan, or written instructions, or a doctor’s note) on our person when we expect to be in the hospital and expect to get the same level of care we would give ourselves rather than something standardized and proven safe in the short-term.
Now, the fact that they do this in the ER and in post-op doesn’t bother me nearly as much as the fact that it’s done in nursing homes and long-term care facilities. In my opinion, THAT’s the grievous offense.
I have a few thoughts- One, I work for a large hospitalist group (the relatively new specialty doctors that act as your primary care doctor would have in the past when you are admitted to the hospital) at an academic medical center and just like primary care doctors they really aren’t trained to take care of type 1 diabetics. Unfortunately, if you are admitted to the hospital for non-diabetic reasons most doctors aren’t going to call for an endocrine consult and instead rely on hospital policy (i.e. sliding scale insulin). I regularly show the doctors I work with my OmniPod and many of them are amazed at the technology. I think that because the majority of diabetics they see are type 2 most of them have to dig deep and remember things they learned in medical school which unless they did and endocrine rotation isnt going to be much. Unfortunately, we will always be are best advocates when it comes to what is best for us. Second is a recent study in the New England Journal of Medicine (Glucose Control in the ICU — How Tight Is Too Tight?
S. E. Inzucchi and M. D. Siegel - 26 Mar, 2009) showed that tighter glucose control actually increased mortality by 10% in hospitalized critically ill patients. While the results aren’t clear why this is the case it is certainly something to think about.