Diabetes Checklist for Hospital stay

I am wanting to prepare in case of the need for hospitalization (for any reason), especially at this time.

I use a Tandem pump and Dexcom cgm. Does anyone know of a checklist or videos that would be helpful for healthcare providers who are not familiar with pumps and cgms.

What would you want doctors and nurses to know?

I read your post soon after you published it, but it’s taken some time to formulate my response. I’ve been concerned about this issue for many years now and it became even more important when I ended up in the emergency room due to shortness of breath last October. Thankfully, I was released after spending about eight hours when all the most likely causes were ruled out.

My response to your question will be limited to hospital stays in the context of this viral pandemic. In the best of times, the medical staff are relatively ignorant of how we manage our diabetes. Their textbook understanding and limited experience is not prepared to treat us as we would wish. With Covid-19 and the chaos that will present in most hospital situations, it is unreasonable of us to expect anything more than minimum diabetes care.

I don’t think we should expect the medical staff to take the time to learn how our pumps work. Bowing to that reality, I think we should all have a recently well-rehearsed multiple daily injection (MDI) plan as a back-up.

Then I would write down on three 3x5 index cards the long acting insulin type, the number of units, and the ideal time(s) of injection. Assume that you will lose this card, so having any extra or two can help. Take a picture of this card with your phone camera.

If you are type 1, write in bold, larger than the rest of the text, Type 1 diabetes.

I would also put on this card the fast acting insulin type that you use with the insulin to carbohydrate (I:C) ratios and the ideal pre-bolus times.

You could also include how much you expect your blood glucose level to drop per unit of correcting fast acting insulin. This is your insulin sensitivity factor or ISF.

You may list the approximate total daily dose of insulin you use (long acting + fast acting).

Write down the name and phone numbers of your diabetes doctor and primary care doc on the index card.

Consider placing this card in a clear badge holder with a lanyard around your neck.

I would bring along CGM supplies, but not attempt to formally instruct the staff in how to place or calibrate it. This will only help you when you are conscious and competent.

Given this scenario, I would pack the following supplies to cover a 21-day period plus extras:

  • 2 fingerstick meters

  • Test strips

  • Insulin, both long and short-acting

  • Glucose tablets

  • Extra batteries for meter

  • Cell phone with charging cord

Label everything with your name and phone number as if you were going away to camp. You may be moved several times and in the confusion your stuff may not make the move with you. Put your name and phone number on the outside of your supply pack.

Realize that your spouse, partner, and any other accomplice may not be allowed to see you. Plan as if you will be on your own.

Going to the hospital during a pandemic will be frightening, yet being prepared ahead of time can help you.

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One thing I really like about Medic Alert brand bracelets is that they have a hotline that healthcare professionals can call. There’s no guarantee that this hotline would be called, but I feel comfortable having life-threatening conditions and medications listed on my bracelet and all other information (medical conditions, medications, medical devices, doctors’ contact information, emergency contacts) available through the hotline.

My thinking of hospitalization is that the only time medical staff are going to need detailed information is if you’re unconscious or otherwise unable to communicate this type of information to them. Yet, in a situation where you’re unconscious or unable to communicate, I’m not sure that detailed information would actually matter. In such a situation, you’re most likely not going to be receiving insulin via pump or injections and you’re not likely going to be eating by mouth. You may be sick and so total daily insulin doses or correction factors may be irrelevant, as you may require two or three or more times your usual doses. In my opinion, the only information that’s crucial for medical professionals to know is to not detach your insulin pump without providing another means of insulin delivery. They absolutely need to know that you’re insulin dependent. But beyond that…I’m not sure much else matters if you’re so sick that you’re unable to communicate the details.

In terms of an emergency hospital stay where you can still communicate and/or treat your own diabetes (I’ve always been allowed to treat my own diabetes when hospitalized), I keep an emergency pack in my backpack at all times that has supplies to last a few days. The kit is mostly meant for earthquakes, but it would be good in any situation where I need supplies and can’t get home (I use it many times during regular daily life, too). I was hospitalized once unexpectedly before I carried this kit, and I had to get someone to go home and pick up additional supplies for me. In this current situation, that likely would not be able to happen. I think it’s probably a good idea that everyone have a small emergency kit of diabetes supplies as we never know when something unexpected may prevent us from getting home.

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I would suggest adding DOB (Date of Birth) to the card as most medical facilities in the US use that to double check they really have the right person.

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I am aware I have the patient right to maintain control of my diabetes while still conscious and able to make sound decisions for myself. Not all hospital staff may be fully educated on my rights, though. Does anyone know of or have links to legal documentations I could bring with me if need be? Something akin to a diabetes-specific living will, or something?

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Thanks for all this good information. Actions I have taken today:

  1. Packed supplies (thankfully I have just received all my orders and have 3 months of supplies. Packed one full box of each of my supplies still in the box, with my name, medical id and doctor printed on box).

  2. Created a medical information card (1/2 sheet size and printed on card stock). Here is the information I added so far.

Your Name

Type 1 Diabetes (or other)

Medical Information

Insurance CO. (name, I have Kaiser Colorado)

Member ID (Insurance ID)

Date of Birth

Primary Care (Dr’s name, phone)
Diabetes Care (I listed three members of my endo. team)

I use a (brand) insulin pump and a (brand) continuous glucose monitor (CGM).
Do not detach my insulin pump without providing alternative insulin delivery.
I prefer to manage my own diabetes care as long as I am conscious and competent. I recommend speaking with someone from my endocrinology medical team.

Emergency Contact: (spouse, roommate, friend)

Other Contact: (name and relationship)

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I would suggest putting them in a plastic cover.they can 5hen be wiped off. Nancy50

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What a great Idea. I can make them 4x6 as I have a small laminating machine.

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This link from Dr. Bernstein’s diabetes-book.com website may help:

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Thanks for this!

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lol. No one is as prepared for this apocalypse as Lisa. A laminating machine? You go, grl!

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Don’t forget about the EMTs.

If you live alone and worry that you could get VERY sick over the course of a couple days, do what they do in the hurricanes. Write relevant personal info on a laminated piece of paper and tape it to your front door where they can grab it and bring it with if they pick it up.

Name:
Date of Birth:
Address:
Emergency Contact:

S (Signs and Symptoms) -
A (Allergies) -
M (Medications) -
P (Pertinent medical history ie major surgeries and stuff) -
L (Last meal) -
E (Events leading up to this incident) -

Make a note of where your emergency bag and insulin is so they can bring it with if you are unconscious.

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Also, if you live in an apartment, it’s a good idea to have a land line. I live in a high rise and have a land line specifically for calling 911 if I were unable to talk. Calling 911 from a cell phone might let them know what building I’m in, but I don’t want them having to go door to door of a hundred suites to find which one called.

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Good idea. I can’t feel the buttons on a cell well enough to use it when my brain breaks. Thanks for the reminder.

You may be able to ask Siri to call 911. I’ve never tried it (wouldnt’ suggest trying it unless you actually need to call).

My thinking when I moved out of my parents’ place was that I’d had several medical emergencies where I wasn’t able to talk. I wanted my address to pop up on their screens when I called, including my exact suite number. My understanding is that with a cell phone they only get GPS coordinates. That might be fine for a house, but it’s not going to tell them what suite number you’re in or even what floor you’re on for an apartment building. So I’ve kept a land line for years for the sole purpose of 911 calls.

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Lisa,
Stay away from the hospital if at all possible. You can sometimes manage just as well at home now with tele medicine and numerous calls if needed per day. I am loading up on sugar free and sugar electorate products, lots of tylenol and ketone stix in case of worst scene.Of course you need to go, yu go, but lets all keep positive thoughts of getting through this with out adding to the nightmare of the hospital.
May we all stay well!!!

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I totally agree about the hospital! In 42 years of T1D I have not had to be hospitalized and only had to go to emergency room once…I was out of town. (Well, there were the times I broke my left foot and the time I dropped an exact knife on my right foot).

I feel that the post here have been very helpful and feel like it was about time I had a contingency plan in place. I hope these suggestions have given other some ideas, too.

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My blogpost today gives a link to this thread. I don’t think it matters if my husband learns to operate my pump and CGM but I need to create a file card necklace.

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My husband suggested this change to the card: Do not detach my insulin pump without providing another means of regulating my blood sugar.

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First, isn’t the control IQ great?

Thanks for sharing this on your blog. I will have to start following your blog. Thanks for giving me these words for what I was already thinking about training my husband to work my pump/cgm if I couldn’t do it.

“If I am too sick to minimally care for my diabetes, I should be in the hospital. If I am hospitalized with coronavirus, my husband will not be able to visit or care for me. Plus he would also likely be sick…”

I live in beautiful Colorado Springs and enjoy a fabulous view of Pikes Peak. It is supposed to snow overnight! Springtime in the Rockies. It will be back in the 60’s soon.

I wish you health! Lisa

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