Diabetes in Hospitals- What's the Deal?

from my blog Don’t Fear Diabetes

So I was thinking about going back to FINALLY trying to talk about my trip, and reminisce about stuffing my face with Spanish ham but some of
the responses I got to my post on my recent hospitalization,
particularly over at TuDiabetes
(I wish there was a way to combine my comments so everyone could see
what everyone else was thinking) convinced me that there’s a lot of
interest in discussing the way hospitals manage diabetes, and diabetics.

First, some more detail on my experience:

If you want the synopsis of what got me to the Emergency Room, you can find it here. The diabetic portion of the story starts at around 8pm Sunday night
(after being in the ER since noon, and not having my BG tested once by
the hospital, though being monitored by me). When I was being
transferred from the ER to the OR, I told the OR nurse that I was
diabetic and I wanted to make sure someone was going to be monitoring my
blood sugar while I was unconscious, and also to make sure that no
glucose fluids were put in my IV. She asked how many times they had
checked my sugar so far, and I told her none. The surgeon came in to
speak to me before I was taken to the OR, and I asked him about my
diabetes. He asked me what I took, and I told him Lantus and Humalog.
He asked when my last dose of Lantus was, and I told him around 11pm
the night before. He told me they’d give me Lantus after the operation.

Not my actual nurse.

I was wheeled into the OR prep room to meet the anesthesiologist. I repeated my concerns about my blood sugar while I was under general anesthesia, and he asked some questions that made it clear that he was very well educated about diabetes. We tested my sugar, it clocked in at 114, and he told me that since I was only going to be under for 90 minutes tops, that I would be fine. I trusted him, and away we went.

When I was recovering back in my hospital room I had my first conversation with my night nurse (it was pushing 11:00 by this point) about diabetes. She tested my blood sugar using a MALE (Most Awful Lancet Ever) and a big Accu Chek meter than scanned my hospital bracelet and test strip bottle (price check on appendixless diabetic in room 413!), and needed more blood for one test than I put in my Freestyle Lite in 3 days. I rang in at a respectable (all things considered) 168 (all numbers rounded to the best of my narcotically dampened recollection). She disappeared to go consult her chart, and came back to tell me that she would be giving my 4 units of Humalog.

MALE: Most Awful Lancet Ever

MALE: Most Awful Lancet Ever

My normal correction factor is about 1 unit to 50 mg/dl, so, even in my drugged state, I was able to some rather frightening math that put my blood sugar at -40 in a couple hours, which sounded an awful lot like being dead. I told her I’d like my 6 units of Lantus and maybe 2 of Humalog. She disappeared to call the doctor. When she returned, she apologized, and said that the doctor wouldn’t change his orders. I was on the “resistant chart” (out of sensitive, moderate, resistant) and so for 168, for my height/weight (I guess) I was supposed to get 4 units. I could refuse it, but I could not get a different amount. Really? A 6’6″, 180lb Type 1 is in the most insulin resistant category? Sounded unlikely.

I refused it, and when she left the room, I gave myself one unit of Humalog from my own pen (I hadn’t thought to bring my Lantus with me to the ER, since I wasn’t expecting to stay at the hospital for more than a few hours). She came in a bit later to tell me that if I gave myself any insulin, I had to tell them. So I told her about the one unit. She then took my wife (who was very kindly waiting with me until she felt the whole insulin issue was resolved) aside, and, with the help of the managing nurse (I’m sure there’s a more accurate term) gave her quite a lecture on why I couldn’t be giving myself injections there and how it made them liable for blah blah blah, to the point that my wife actually came in and took my kit with her when she went home, which would not normally be her nature to do.

I asked the nurse (who I should mention was very sweet and clearly feeling very conflicted about the position the hospital had put her in) to test my BG again about an hour after I took my one unit. 197. Clearly we were dealing with non-standard insulin action post-surgery. I decided not to do anything. But at this point, I was more than 24 hours past my last dose of Lantus, so I knew that I had to have insulin within about 3-4 hours after I took my last Humalog. As that moment approached, I asked the nurse again what my options were and if, knowing that I had given myself a unit already, they could give me 3 instead of 4. Nope.

She did bring the head nurse in to talk to me, and I basically gave the most eloquent speech I could about how hard I’ve worked to learn about my disease, and treat myself, and how I only have myself to rely on for care 99% of the time and how good my numbers have been recently and how, of all the places I’ve devised contingency plans for (beach, airplanes, foreign countries etc) I never imagined that the place I’d have the most trouble would be a hospital. In my mind, it was very articulate and persuasive, but I was on a lot of dilaudid at the time, and may have been drooling on myself.

I typed "dilaudid" into Google Images and this is one of the first results, so I'm using it. There is no connection to my story at all.

Anyway, they said they did not have the power to change doctor’s orders, so it was 4 units or nothing, but that they would monitor my sugar as often as I’d like. I asked if I would be given IV glucose if there were a hypoglycemia problem. They said yes, or maybe crackers. The meter scanned my bracelet, I’d just had surgery on my abdomen, there was an IV already in my arm, and they were going to use crackers. I said I had to take the 4 units, because I had to have insulin in my system, especially as I was trying to heal from surgery, but that if they noticed my BG dropping rapidly, I wanted glucose, in my IV. No crackers. They said OK, and I took the shot.

Prescription Crackers

The irony (if you want to call it that) is that even with those 4 units, my sugar stayed pretty stable just below 200, which, normally would not be acceptable, but I talked with my endocrinologist the following morning, and he said that under 200 was ok, and that it was best not to fight with them about the insulin, since they weren’t going to change, and I needed them to do a lot of other things for me while I recuperated.

Anyway, I won’t go through step by step the rest of my luxurious stay in the hospital, which did include a meeting with a diabetic nurse specialist (who really knew her stuff and got me on basal, prandial, and correction insulin), and convincing the nurses to let me lance myself with my Multiclix instead of the MALE which was leaving big awful bruises on my fingers. Still, I wanted to tell the story of the first night because I think many of us would have taken for granted that we would get good diabetes care (or at least be allowed to manage our own) while in the hospital.

I would love to hear what others experiences have been.

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When I was admitted to the ER several years ago–they also did not want to follow my isluin regime and did crash me…even with my endo coming everyday (I was in the hospital for a month) they did not like his orders and sometimes did not follow them. I was lucky as midway through my stay my pump arrrived…it was the end of the fighting…but the endo still checked everyday…I love my endo (everyone in his Practice actually)

I did alot of nurse training while I was in the hospital–there is so much they do NOT know…it is SAD furstrating anhd VERY DANGEROUS.

I had a family member in the hospitla 24X7 to make sure no idiocies occured (my daughter cuaght them hanging the wrong stuff on my IV more than once)…

And it hard for hospitals o feed patients allergic to soy because most of what they make is prepared/boxed (cheaper than having actual chefs and real cooking staffs) full of soy and all the other bad stuff…

I went to the ER once when I was about 12 with a glucose of over 400, and obvious DKA(vomiting ,etc).They had me sit in the waiting room for 4 hours and only gave me a cup of ice chips!

Another time I went into the hospitalfor a kidney infection(not diabetes related,thank god) and they insisted on taking me off my pump,so what originally was estimated to be a 4-7 day stay in the hospital became 14!In turn my highs school guidance counselor lied to my mother about my grades and told her the only way i would pass 10th grade was to go into home bound schooling.When I left school I was in honors geometry and doing well,but i’m a visual learner and the homebound classes took place over the phone.So I ended up having to drop math that year and when returned to school the following year ended up having to repeat geometry ,but this time the regular class. Totally screwed up my GPA for a scholarship I was going for as well.

When I was 17 I got a flu and my mom brought me to the ER after much protest on my part, because at this point I have learned I can usually get my blood sugars down way before the ER and they typically try to admit me,adn keep me for a week even though I’m better usually by the following day. Any who, this time they surprisingly decided not to admit me,but wanted to give me insulin to try to lower my glucose level, even though i was on a pump.So after arguing with the nurse in my flu like state I gave up and let them disconnect my pump and give me insulin.Needless to say an hour later I started to go low,so they brought m a sandwhich, crackers,and an O.J. I ate the sandwich and the nurse came back a few minutes later and said “why didn’t you drink the juice and eat the crackers?” I asked her if she had any diabetic education,because if she did she would know that is way too many carbs and I would end up sky high at which point they would probably try to admit me for yo-yo’ing blood sugars,even though it would clearly be their faults. She got mad stormed out and got the doc.I explained to him what happened and he turned to the nurse and said"You know sometimes the patient is right." I thought Ha! Take that B****. (sorry).Finally after like 4 hours there i got to go home.

My most recent experience waas when i accidentally dropped and broke a bottle of insulin(costly accident in more ways then one).it was like 9pm so docs offices were closed and i was literally out of insulin,so i went to the ER and explained to them what happened. They said they would have no problem writing me the script and getting it filled.The doc came in asked me how many injections I do,and I said I have a pump.The guy got bright eyed and said"can I see it? I haven’t seen one up close." I thought seriously,and showed it to him and explained the basics. Then he asked me how to write the script. He said he hadn’t done it since med school! I thought how is he to be any help to a diabetic that comes into the ER with a serious emergency? It’s crazy.

I’m amazed after having diabetes for 22 years,and having the pump for 9 how few docs know anything about diabetes.

All I can say is STAY OUT OF HOSPITALS if you can help it. It’s a last resort. A few times I’ve met some healthcare professionals that knew a little but most didn’t have a clue. One hospital I wasn’t sure I was going to make it out alive. My sugars were high and I was DKA and they gave me an iv with glucose in it and wondered why it wasn’t dropping my blood sugar. Always have someone who knows about your diabetes with you to advocate for you. Once you need to be in a hospital because of highs or lows, your brain getts muddled and you may not make the best choices. So best advice stay out of hospitals.