Diabetes Care in the Hospital: It Ain’t Pretty (Diabetes Mine blog post)

WOW!! A doc who says "tell me what you need"!!!! I think that's one of the first things anyone in the medical industry who might cross paths with a PWD should learn to do: ASK US WHAT WE NEED. Anyone who thinks they know better than we do truly has no idea what having diabetes is about.

Great idea, Terry!!! Do you know about the Diabetes Advocates? It's another program of Diabetes Hands Foundation (parent to TuDiabetes), and it's exactly the group to bring this idea to!! Check them out :)

Well I have no hospital experience as a diabetic, but I've found something that MIGHT be disturbing about my unit secretary text book. I'm studying to be a unit secretary...and there's absolutely NO mention of Diabetic Ketoacidosis whatsoever which would be important to include in someone's medical history and also should be watched for if you're a unit secretary and a patient comes to the nurses station with concerns that they might be in DKA. I mean you can relay it to the nurse but if you don't know how serious it is, your actions might be different than they should be There's not a huge focus on symptoms of low blood sugar either. The book is out of date and does not mention how rapid insulin works despite being printed in 2013. Also it doesn't go into the different ways that insulin may be charted and when to be aware that they might need to adjust it based on the patient's age, weight, height,overall insulin requirements. Unit secretaries are incredibly important to keeping and coordinating patient care so they should be pretty aware of how medications work and how certain chronic illnesses work and what could be considered a medical emergency? Right? I feel like the book covers a lot of other chronic illnesses well just not diabetes. I feel like it might be related to the stigmas related to diabetes and how people don't see it as a very serious disease. I hope the teacher goes into it more or else I"m gonna worry a bit :( .

These stories are shocking. I've only had a couple of outpatient procedures done since I got my pump in 1990. I was able to keep my pump on, and I don't recall any serious problems.

I would really like to see what Dr B said in that letter Marty, is it really long or could you take a picture of it or something. I'd like to keep it in my files.

Oh yes the hospital. I had my first surgery for thyroid cancer in July. I wasn't allowed to give insulin so of course I came in with a fasting of 180. They wouldn't treat it and then admitted me after the outpatient procedure due to vomiting and low oxygen level. They did give me Levemir but did some weird sliding scale with Novalog, said they don't do Humalog. My second surgery was in August. I was supposed to be admitted but talked the doctor into letting me go home even tho I had vomiting and low oxygen level again. But of course no insulin even though I was running over 200. I stayed in the 200 to 300 range for days after that. Do I hate the hospital? Yes very much.

It would be great to hear from some nurses, doctors, and other medical professionals on this thread. There's always more to the story than we see at first.

Do they see this as a problem? Are they constrained by specific hospital policy or protocol? Do they understand that more education is needed? Why do they seem to dismiss the expertise of insulin using diabetics?

I'd like to understand more from their point of view! I know they can shed some light on this medical system dysfunction. Please express your take on this. I am seriously interested in what you have to say!

found it - Dr B's letter
http://www.diabetes-book.com/cms/index.php?option=com_content&id=1703

Thanks for posting the link, Marie. I'm saving for future reference.

I'm wondering what the hospital response has been to this communication when used. I'm also wondering how well the hospital and its staff followed the letter and spirit of this letter. I'm hoping that some nurses, doctors, and other hospital medical professionals will express their take on this issue.

I have been giving some thought to insulin for PWD's in hospitals since my release from the hospital. Now, for me it was an emergency situation, I had no insulin with me, and I spent most of the time there under the influence of morphine or something stronger. The hospital's policy (no basal, glucose monitoring and correcting every six hours) insured that neither I nor other patients would die of a hypo while deeply asleep. As a Type 1, however, I did need a minimum amount of basal, which my doctor prescribed. To insure that noone goes into DKA, I truly believe they should try to individualize the care, giving a minimum amount of basal to patients when indicated.

In an unplanned hospital visit, or one when the patient isn't really able to help himself, letters are irrelevant and the policy in place is all important. Of course, there is some difference when one is on a pump, or like me on MDI.

Artwoman started a discussion in the Insulin Pump Forum regarding Kaiser NWs new hospital policy for those using Insulin pumps. All their pump users received a letter saying that on admittance pumps would be disconnected & no reconnection until discharge. There were no details about what alternative treatment would be used.

My experience except in ONE instance, has been complete ignoring of my personal dr's wishes, my wishes, my families wishes etc, up to the point where they sent a police officer (I would not allow hospital security into my room) so they called the local cops, and HE took my insulin, syringes, pump, meter, test strips, and a bottle of antacides away from me. Then proceeded to take the stuff off premises to lock it up at the police station. Of course, when I got out of the hospital, 3 months later, I was told that they had not kept my insulin refrigerated so I had to throw away 2, brand new bottles that I had brought to the hospital with me.

The one instance I mentioned, after 2 weeks of fighting the nursing home, the new Dr I was assigned (again, ignoring my personal care dr) decided to let me try it my way... lowe and behold, my sugar(s) were subsequently back under control within 24 hours, after two full weeks of them keeping me at over 600! That Dr is now one of my personal care dr's but I live in the boonies, so it is a pain to have to drive all the way into Scranton PA just to get a script for insulin. Here, in PA, you MUST have a script to get insulin or syringes where other states allow you to purchase them without said scripts. So, here it always cost's me or insurance a Dr's visit PLUS the cost of the meds...

It is their waste of course, but they count it against you lifetime total, and despite Obama Care claims to eliminate that max, all they did was raise it. So, lifetime max is still sitting at 2 mil, and when you have multiple surgeries, that money is gone quickly.

I also have DNR's on file... this last time when they went in to take my leg, I woke up the next day with severe chest burns from them resuscitating me... not something I wished to have happen. Of course, in this particular case, they sorta knew they had no choice, because there was no reason for me to have been killed on the table, other than their own medical staff's incompetence. They never would admit to resuscitation or what happened to me in surgery.

You ABSOLUTELY MUST have an emotionally strong family member around whenever you go into a hospital anymore. Otherwise your care will not be sufficient and may end up being life threatening. It was a Dr's fault that I lost my leg. Yet, I can't fight him in court because there is a long history of diabetics losing limbs to the disease over the past 50 years. Typically caused by incompetence in the Dr, not the patient, but they will NEVER admit that.

Hospital's scare the hell out of me now. I now have three different versions of MRSA (you get a different variety from every single hospital you are admitted to). So, once I inform them of that fact, they immediately assume that my high white blood count is caused by that, and not the fact that I actually may have a REAL infection somewhere... or whatever. Royal pain. I also end up with nursing staff (not going to necessarily call them nurses either as nurses aides now do what used to require an RN's license, which means the Rn's are pissed because they can no longer get paid what they should be paid for their higher education. The hospitals and nursing homes / recover homes all hire nurses aides as much as possible, typically leaving an entire location under the care of a single RN.

I am at a loss for words to respond to the hospital sending in the police to confiscate your diabetes treatment tools. Dr. Bernstein writes about this practice in the sample letter for readers of his book, Diabetes Solution.

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.

I fear that even if you submitted a letter like Dr. Bernstein suggests, that unenlightened hospital would have just ignored it. This is truly outrageous.

Thanks for posting the link to Dr. Bernstein's letter, Marie!

And thanks to everyone for posting your experiences and concerns about this topic! I haven't had to be in the hospital since I've been diagnosed, but it's something I'm concerned about. It really helps to read about what others have experienced.

Thank you also, Terry, for seeking input on this subject from medical professionals. There are certainly caring, knowledgeable and conscientious medical professionals out there! It would be helpful for all of us to know more about whether they are under constraints that we aren't aware of regarding their approach to people with diabetes in the hospital.

Or is there a woeful lack of education provided to them about how to take care of diabetics in the hospital?

May we all be safe (or as safe as possible)!

Best wishes to all,

marty1492

Wow, maybe I am just lucky so far, but I have always had full control over my diabetes while in the hospital. I've only had one overnight stay since my diabetes diagnosis, but have had numerous visits to emergency. In every case, doctors have been completely relaxed about me managing my own diabetes. The time I stayed overnight I had to let the nurses know whenever I tested my blood sugar or took a bolus, so they could record it. In emergency, they don't seem to care what I do. I asked a nurse about it once and he said that if a patient seems to know what they are doing with their diabetes he tries not to interfere. Maybe I have just been lucky so far, but if so I hope my luck keeps up!

Some very very scary stories here. I have learned that when in the hospital one needs someone else, a family member or friend to strongly advocate for you especially if you're diabetic.

It seems the nurses and doctors have a tendency to want to control every aspect of your life and usually the response time to problems is ridiculously slow. Sometimes you can work with these people, but sometimes you can't. They have to be willing to work with YOU.

I think it's true what James Hirsch said about hospital staff believing there are two things you can't have enough of: sex and sugar.

In the list of what ERs deal with, I imagine they believe high BG isn't as an immediate threat as low BG or stroke or heart attack.

Had my appendix out elective surgery yesterday. They made me take pump n sensor off and told me they’d monitor my diabetes while under their care. This was at St Catherines Hospital in Smithtown, NY.

At 5pm they tested my blood sugar and it was 385. They gave me a small does of correction insulin but no IV insulin to be used as a basal drip.

I put my G6 back on and starting doing finger sticks. When my blood sugar was at 420 I started my freak out. Nurse never responded when I hit call bell. I unhooked my iv and went to the desk where my nurse who just got there was eating day shift cake. I told her I’ve been waiting 45 minutes and my blood sugar is now 450.

I heard the nurses saying how is she testing her blood sugar? I got up told them I was smart enough to bring a tester n my G6 was up and running. So I had 2 ways to check my blood sugar. This was at 7pm. Again I told them I need insulin and they told me I had to wait for meds until 9pm when I’m at 450.

This is when I got dressed. I told them it’s obvious you can’t take care of a diabetic who just had her appendix out. I had to leave to get home take insulin and check urine for ketones.
The strip turned bright purple which is not good. I woke up with 385 and I’m finally down to 97.

I’ve spoken with Medicare, department of health, patient advocate from hospital. I think I’ll get the most out on the NY DOH.

Is there a Diabetic Association that deals with diabetic negligence?

Thank you,
Christa

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I ordered insulin at the pharmacy it didn’t show up. It said” delayed “ in the status section, So I had to go in there in person to get some. I was down to 6 units in my pump.

They told me it will be shipped today and I’ll receive it in two days or less.

I laughed and said “ I take 50 units a day, and I have 6 to last me 2 days. “

I asked for just one vial to tide me over.

The pharmacist told me “ if you had ordered earlier you would have it. And now you will have to wait 2 days, a lot of people skip a day.

So I drove to my doctors office and explained and I got a new script for one bottle.

But really it makes me feel like so many health professionals do not understand insulin.
They can’t wrap their heads around the 24 hours a day 7 days a week, or we die kind of thing.

But a pharmacist or a nurse or a doctor. There is no excuse.

I need to go in for a colonoscopy. And they wonder why I’m so worried about having it done. I’m getting an anesthesiologist who is type 1, so I figured someone in the room will know what’s up.

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Inexcusable in both cases, but somehow not surprising to me. My experience with the hospital during two surgeries I had in southern Calif left me believing if I ever had to stay in the hospital it would be horrible care and I’d be in trouble.

Where I have moved to, the DE, who is a type 1 is connected with the hospital and can be called on to help. Supposedly they let you keep your pump and monitor yourself if you can, at higher numbers that are more comfortable numbers for them. . Unless it’s diabetic related like DKA, then you are in their hands and no choice.

Too many health care workers do not understand. A huge lack of education. One of the health workers, she had a degree, I don’t remember what it was, when I complained about going high while swimming she said can’t you plan it better and do what you need to the night before so you don’t go high??? I was shocked and wish I had replied that doesn’t even make sense. But she left me completely dumbfounded. This was within the last 8 months.