CHI-St. Lukes Hospital - Conroe, Texas - Public Service Announcement

For starters, Our daughter a patient with Type 1 Juvenile Diabetes was admitted for an issue that initially was not related to diabetes. The day nurse took blood sugar readings every two or so hours. The patient’s blood sugar was ‘over 500’ for almost 12 straight hours (except for one reading in the 480s after the patient gave herself some of her own insulin) and no insulin was given by the hospital from 7 or so in the morning until after 6 in the evening, despite the patient’s repeated requests. The patient was later told that the nurse didn’t know that the blood glucose meter ‘capped out’ at 500.

Medical records are available for those who find this as unbelievable as I do!

could someone have brought a bg meter/insulin into the hospital on their own and let your daughter inject? hospitals are a scary place all around. the nurses are over worked.

She had insulin with her and, 6 or so hours into it, she did dose herself conservatively. The floor supervisor came into the room, reprimanded her and threatened to have her discharged for doing so! Nurses being so overworked that they cannot properly treat their patients or call their patients’ doctors, and not knowing how the equipment works, is the fault of the hospital not the patient.

1 Like

I am so sorry to hear this happened to your daughter!

Unfortunately, experiences like hers are far too common. Cases of Type 1 diabetes (or any insulin-dependent diabetes for that matter) are still in the minority of all cases of diabetes. Which means that medical personnel, including physicians who do not specialize in endocrinology, are woefully undereducated and inexperienced. This, however, is an explanation and NOT an excuse. In the big picture, I place my blame with the health insurance industry, whose penny-pinching ways quickly trickle down to inadequate numbers of staff working in our hospitals, impossibly heavy workloads, and the inevitable medical errors that ensue.

Fortunately for my daughter, I had the opportunity to read many of these horror stories so was prepared when my daughter was scheduled for a major orthopedic surgery (bilateral femur rotational osteotomies). I spoke at length with hospital staff (mostly her surgeon and especially her wonderful anesthesiologist) prior to her hospitalization and made it clear that I would be present throughout her hospitalization and would be SOLELY in charge of her diabetes care. Her anesthesiologist even kept in close contact with me during her surgery while he kept an eagle’s eye on her Dexcom receiver and checked her BG via fingerstick whenever I requested, in addition to administering any correction doses of insulin per my request via her pump. I made it clear that I was to resume being at her side the moment her surgery ended at which time I resumed total responsibility and control of her T1D care. Of course my successful plan was made a little easier by the fact that I am a physician. But because I do not have privileges at this hospital (because I do not specialize in Orthopedic Surgery, Neurosurgery, or Anesthesiology, the only medical specialities at this particular hospital) it was still a major feat to establish this plan and agreement, once again thanks to the health insurance industry and their fear of possible litigation should a bad event occur. While it can be more difficult for non-physician parents or other family members of PWD to take responsibility for and control of their hospitalized loved ones’ D-care, it is not impossible. It just takes one or both of two things: involvement of the PWD’s endo from square one and a great deal of assertiveness. I firmly believe that the latter is more important than the former.

Thank you for posting your negative experience; stories like these help raise awareness of this unfortunately all-too-common scenario that occurs when a PWD is hospitalized. I wish your daughter a speedy recovery and Happy New Year!

3 Likes

I won’t repeat what has already been said so well. I am just a wee bit flabbergasted that this would happen at St. Luke’s, of all places. You wouldn’t think a facility with such a sterling reputation would be as subject to the standard misunderstandings and fallacies as lesser hospitals. Ah, well. Live and learn.

1 Like

I am not surprised by this report at all. The longer I have diabetes and consult with the so called “experts,” the endocrinologists, the more I realize that my skill at insulin dosing is rare.

Combined with the fact that I am not a doctor, I expect major conflict with any hospital that cares for me. I would hope that my endo would back me up but I can’t be sure of that until it happens. Perhaps I need to have a heart-to-heart with her.

My stance is that as long as I have cognitive, visual, and dextrous ability, I need to be the one making all the decisions and treatment with insulin. I would hope that hospital nurses and doctors would support this set-up but I fear that professional pride and willful ignorance may present major roadblocks.

I’ve heard more than one nurse at day-surgery comment that they like to run their diabteics “sweet.” They even have a name for this – permissive hyperglycemia! They have no idea how dangerous this euphemism can be. Studies have shown that rates of infection and mortality as well as the length of hospital stay are adversely affected by hyperglycemia.

Improving this social health care malady will take a sustained effort from many quarters, including informed patients and diabetes advocate agencies. I think we should each prepare for this contingency.

2 Likes

+1, Terry. I dread the day I have to be hospitalized. Nobody knows how to manage my insulin the way I do, and I will neither accept nor tolerate substandard management by someone who doesn’t know better. There are likely to be fireworks.

1 Like

I would love to hand over the burden of my diabetes care to competent hospital staff. This care is squarely their responsibility. It would allow me to focus my energy and resource on regaining health. The fact that they are ignorantly incompetent at this duty outrages me. I realize that this problem spans a whole list of people including, doctors, nurses, dietitians, hospitalists, administrators, nurse’s aids, and endocrinologists. If I could limit my response to just “fireworks,” I would consider that a success.

I’ve considered having an advanced directive at the local hospital that if I’m conscious and coherent I will make all my own insulin dosing decisions and administer them myself and if I’m not it will be up to my wife, only if she is unable would the responsibility be handed over to the hospital staff… I’m not sure the finer points of how advanced directives actually do, or don’t work or if this type of specificity is actually allowed for, but I like the idea

1 Like

This letter is reproduced from Dr. Bernstein’s Diabetes Solution, Appendix B. It may serve as a good reference to facilitate discussion with the hospital before an elective surgery.

Dear Dr. __________:
I am scheduled for admission to your hospital on __________. I have type [1 or 2] diabetes and am naturally concerned about control of my blood sugars while hospitalized. It is now generally accepted that elevated blood sugar levels impede recovery, prolong hospitalization, and increase the incidence of hospital and surgical morbidity and death. Major health problems brought about by inappropriate blood sugar elevations during hospitalization have justifiably lead to litigation. Since I have been successful at keeping my blood sugars essentially normal around the clock, I naturally expect equivalent care while I’m in the hands of medical professionals. I currently take the following medications for controlling my blood sugars:

[List here doses, times, and purposes of medications: “basal insulin (or ISA) to cover the fasting state—must be given even if not eating,” “prelunch (breakfast, supper) insulin (or ISA), to be skipped if meal is skipped.” Detail also any use of insulin, glucose tablets, or liquid oral glucose for correcting off-target blood sugars, etc. You may also include a sample GLUCOGRAF sheet and request that all medications used by the hospital that may affect blood sugar be listed on it if you are not capable of listing them yourself.]

My hospital orders should call for a “normal diet” and not a “diabetic diet,” so that I can select my own meals.

Routine intravenous fluids should not contain caloric substances such as glucose, fructose, lactose, lactated Ringer’s solution, or saline with added glucose (except for treatment of blood sugars that are below my target). All of these substances will raise my blood sugar to unacceptable levels. Normal saline solution is perfectly adequate for routine hydration. My target blood sugar is ___ mg/dl. If I am conscious and without cognitive impairment, I should have full responsibility for treatment of my diabetes—without outside interference. My blood sugar meter and blood sugar control medications, including insulin syringes, should not be confiscated by hospital personnel. This is a barbaric practice that is rapidly being abandoned in modern hospitals.*

If I am unable to care for my own blood sugars, I expect that the hospital staff will exercise every effort to maintain my blood sugarswithin the range of [00–00].

Sincerely,

cc: [Hospital administrator]
[Close relative or friend]

This letter may also be of value if you are to have certain outpatient procedures, such as endoscopy, cataract surgery, hernia repair, and so on. These are frequently performed in physicians’ offices or in hospitals without the requirement for staying overnight.

  • Many hospital pharmacies do not stock the products that we commonly utilize in this book, such as 25–30-unit insulin syringes with .-unit markings, detemir (Levemir) or glargine (Lantus) insulins, and lispro (Humalog) or aspart (Novolog) insulins.
5 Likes

Terry4, thank you so very much for posting this sample letter. Perhaps everyone with D should prepare and keep such a letter with them at all times in the unfortunate event that an emergency hospitalization should become necessary!

Unfortunately my health care plan requires that I go to “their” hospital. The Endo dept requires that PWD1’s “surrender” their pumps CGM’s and meters. So my response is refusal to be admitted. If I am aware enough to complain that they aren’t monitoring my bg enough - I am competent to be in charge of my D. In other places, when I’ve had day procedures the surgeons and especially the gas-doctors love my CGM and let me determine where I want my bg to be.

1 Like

Our daughter a Type 1 diabetic patient was admitted to a hospital for observation. After 2 weeks that included no insulin to treat high blood sugar level for almost 12 hours and not administering antibiotics for an infection for about a week, patient was discharged on palliative care.

Flash forward 11 months…patient is admitted for the same infection, and was discharged 2 weeks later not only with the infection, but with blood clots from the wrists to shoulders of both arms.

She was asked to leave hospital and to be transferred to another hospital.

David: The facts are the facts.

While I’m sorry to hear that your daughter is having a rough time, I have to say that what I’m seeing is a lack of facts. How old is your daughter? What was your daughter’s diagnosis(es) on admission? What particular infection did she suffer (i.e. what bacteria or virus, where did the infection initially present?) Was she asked to transfer to another hospital because they were better equipped to deal with her particular conditions? What was her BG control like before she became sick enough to require hospitalization? Any additional underlying illnesses?

2 Likes

Absolutely, facts can be made available to you. Are you an endocrinologist?

The question I have is what treatment for diabetes was the hospital informed of? What did her doctor do to ensure that the hospital would continue her treatment as it was before she entered the hospital?

I frankly am not all that surprised that they would not take a patient’s word for how a prescription drug, insulin, was supposed to administered. And when in doubt, the rule in medicine seems to be to do nothing.

Was this all clucked up? Most certainly. But what is there in your daughter’s hospital records that the hospital ignored to her detriment?

[quote=“Type1Hotties, post:16, topic:50185, full:true”]
Absolutely, facts can be made available to you.[/quote] I think the “facts” would be interesting. I do wonder if your daughter minds you offering up her medical records though, my daughter would be outraged if she were to see me posting her medical troubles on boards and forums. Maybe it’s just me, but I find the discussions (all over the DOC btw) I see on this story puzzling. At first you talk about “For starters, Our daughter a patient with Type 1 Juvenile Diabetes was admitted for an issue that initially was not related to diabetes.” and then the troubles with bg and insulin, but she was able to administer insulin on her own and when these details are shared the daughter becomes “the patient”. And then you offer up “Medical records are available for those who find this as unbelievable as I do!”

The facility your daughter the patient was treated is an excellent place for one with heart issues. They house the Texas Heart Institute and know what hey are doing, usually. In addition, they are affiliated with the children’s hospital. It seems to me that you want to file some sort of complaint and/or accuse a hospital for not treating your daughter, the patient proper. This should be done elsewhere.

We all want to know what happened, where your daughter the patient is now, and how she is doing. Some basic facts I’d like to know are age of daughter the patient, the issue that initially was not related to diabetes, why she could not keep giving herself some of her own insulin.

The hospital was told that she has Type 1 Juvenile Diabetes, and that detail was confirmed the evening of the day that she was not given any insulin. It was unfortunately not her first visit to that particular facility but it was the first time they denied her medication.

Her records for that hospitalization contain numerous entries from doctors that say “I do not see that my orders were followed”. In addition to insulin deprivation, there was one from an infectious disease doctor who was concerned on day 7 that ‘they had not yet administered any antibiotics’ (white count went from 11,000 to over 23,000). The worst part of it is that the hospital is in total denial - they will not take responsibility for this situation.