Covid-19 exposes hospital staff to diabetes tech

Diabetes Technology Commercial Closed Loop Systems
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This NIH review, published in January 2021, examines in-patient use of insulin pumps and CGMs (continuous glucose monitors) in the hospital setting. From this patient’s point of view, hospitals and medical professionals have been slow to formally address the diabetes tech that we patients use every day.

Many of us find this technology contributes greatly to our quality of life and can’t imagine going without it if we enter the hospital. Of course, there are good reasons why disconnecting our pumps and CGMs can be entirely appropriate. But there are also many circumstances where staying connected can help the patient and hospital staff while also producing a better health outcome.

I found this review to be up-to-the-minute and comprehensive in its coverage. If you like reading diabetes studies then you’ll likely find this review interesting.

These ground rules are found in the On Admission section:

Patients should not make changes to their pump settings without first discussing with hospital staff [6]. If possible, the target glucose set within the pump should be adjusted to 140–180 mg/dL, as per ADA guidelines for critically ill and non-critically ill hospitalized patients with diabetes [1]. Patients should be made aware of these targets, as it likely differs from outpatient goals [6]. If hospital policy dictates a signed patient agreement, the agreement should delineate the responsibilities of the patient to manage their device and include consent to share pump settings and information with hospital staff and to report any issues [2, 3, 9].

Agreeing to target 140-180 mg/dL does give me pause. I have strong opinions about this but I’ll save them for the comments.

It appears that Covid-19 has forced the issue of diabetes tech in the hospital. Historically, human institutions resist change. Many of us who have spent time in the hospital have been alarmed by how much medical professionals don’t know about diabetes. This doesn’t apply to all hospital staff but, in general, diabetes knowledge is deficient. Let’s hope that the exposure gained by Covid ICU staff with CGMs can create a more general acceptance of this tech in the hospital setting.

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They have done a lot of donations to the hospitals during this time. Its pretty commendable. Normals are getting goofy BG, too, with covid.

This is an excellent audio interview about it: Making CGM Systems Available To Hospitals: What You Need To Know - Diabetes Connections

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That is an interesting document. It does not anticipate high BG and insulin resistance caused by inactivity.

I wonder if a living will document would be enforceable for specifying the patients right to specify insulin type and dose, target BG, when/how to use correction bolus or temp basals, etc.

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When I was in the hospital for about 30 hrs for chest pain, due to stress a couple of weeks ago, nobody gave me any grief at all about my diabetes. I don’t use a pump but do have a CGM.

I kept my pens on my tray table and used them whenever and however I wanted. The nurses asked me what my glucose levels were, but never did a finger stick. Once in awhile I would ask a nurse if she would like to know how much insulin I gave. I was also totally in charge of what I ate.

When in the hospital I want to be in charge of how my diabetes is treated, but if I was very ill and the hospital was busy, keeping my glucose levels at 140 to 180 might be safer for me in the long run. I don’t like those levels, but I don’t want to accidentally become hypoglycemic either.

I have no idea why no one interfered with my diabetic care, but I imagine the hospitalist, who was actually excellent, read my records and assumed I knew what I was doing. I also think everyone is overwhelmed with trying to take care of Covid patients and trying to keep things as clean as possible.

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I think that’s really fantastic, @Marilyn6. Maybe things are changing.

Way to work with them. Your sophisticated enough to know how they wanna play ball. I think thats’s important to call out. Well done, Marilyn, well done, Hospital staff!

You might consider writing them a letter about it after all this blows over.

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