I recently was hospitalized for an infected gall bladder. I told the admitting physician that I would be managing my own diabetes and there will be no further discussion on the subject. After the physician took a breath, he said that we could work with that.
Throughout the day prior to surgery I received IV fluid and antibiotics to try to curb the infection before surgery. I had raised my basal in the pump and continued to monitor as normal. Using my meter to control my pump, and the hospital's meter to appease them, I found that the two meters were 20-25 points apart. I was asked to turn off the pump at 11:00 p.m. and they brought me 10 units of Lantus. I took the Lantus and at 3:00 a.m., my blood sugars had gone up twenty points. I turned on the pump and never looked back. One half hour before surgery, (11:30 a.m.,) I check my blood sugar again, and about 145. I correct with a half unit and called my CDE to ask if that was alright. I took my meter to surgery with me. In recovery, a sharp recovery nurse noticed my meter and check my blood sugar after surgery. It was 114. Later that night, they came once again with Lantus. I refused.
Moral of the story. Insist on managing your own diabetes if you are using a pump, and are capable of doing it. Hospital staff has no idea as to the theory of diabetes management via pump therapy.
Brian, thanks for the post. I’m not sure that it works that way in all states but I know here in Mississippi that you can get your doctor to allow you to self-medicate. They don’t like it much though. I think it’s because the hospital looses out on some of that markup they can apply for testing and injecting. In some ways I wouldn’t mind them doing my testing and insulin injections if they would act like they had a clue. Never get my before meal test or insulin and then trying to get them to test again a couple hours after I eat just seems to be over kill to them. So now I get permission BEFORE I go to the hospital (if possible). I can do better myself.
I haven't gone on a pump holiday or really ever had to replace the fast-acting pump insulin with a long-lasting insulin like Lantus, but I have read that you just can't swap them back and forth. Basic logic alone would tell the hospital staff that, I would think.
Really a bit surprised that after getting agreement to let you manage your D, they kept trying to give you the Lantus. I would have been pretty upset and would have calmly insisted they explain why their solution was going to create the best patient outcome.
Thanks for posting this. It's important to remember that a hospital cannot really "require" you to do anything. If you're insistent about managing your BGs, you can do so. That has always been my understanding.
Good for you, Brian. You must be your own advocate when it comes to diabetic treatment. I always take my meter and insulin with me ( I am not on a pump) especially when I go to the ER. I have found that most doctors and nurses are clueless about how to handle diabetic treatment. And it seems to be universal across the US. Sad.
I agree with you 1,000%!! I have spent many weeks in hospitals and rehabs in the last 5 or so years. I had to take a firm stance, too. Although, it doesn't help if you aren't carrying your stuff at all times. I've lost count of my ER admits. Of course, I'm not carrying my inserter or reservoirs OR my Humulin RU500, etc. I just stick it out until I get a friend or my DR to bring in supplies. Then, to top it all off, the phamacists act like there is no place in the city to get the insulin!! (Bull feathers!)
Another thing is that, according to the manufacturer of my glucometer, it is acceptable to have a 25-30% difference in meter readings. The last time I was in the hospital on an unplanned basis, we started seeing over 100 points in difference. They made me get a new meter!!
I know that the so-called professionals are pretty clueless as to insulin management. The last ER visit happened when I was reading too high for my meter. My visiting nurse was with me at home at the time and she insisted on calling the paramedics. You know, 4 hours in ER was spent sleeping [mostly] with NO insulin or further attention to the numbers. The only thing that was happening was that they wanted to admit me ONLY if I would agree to go to a longterm care facility! Oh, they didn't like how many times my oxygen saturation levels fell to the low 80's. Moral of story: Ya just gotta slap them on the noses with a rolled-up paper and get their attention back to the issue at hand ... my overly high BG. I went home in the wee hours and woke up within normal healthy range!!
I was in the hospital before Christmas and I insisted on doing my own insulin and they weren’t happy. They wanted to “hold” my insulin for me and I said no – that defeated the whole purpose of doing it myself! Because of gastroparesis, I do a lot of small shots. I can just see trying to convince some idiot nurse that I need my Apidra so I can take 1 unit when my BS is 95. Once they knew that I was doing my own, the nurse’s aid would just come in and I used my meter and gave her my blood sugar.
I had some bad Levemir and was waiting on a replacement box. I was using Apidra every 2 hours for my basal but didn’t tell them that part. The highest I went was 128 and I had one low of 65. Of course that had to happen when the nurse’s aid came in. About half an hour later, a nurse came running in and you would have thought that it was the end of the world because I was 65!
One thing I will do for the future is put Dr. Bernstein’s sample letter in my purse and emergency go bag. The day I went to the hospital, I was pretty sick. When they decided to admit me, I wanted to go to another hospital several hours away to be in the hospital with the wound center I go to. I went before noon to the ER and it was after 10 when the other hospital was going thru the admission’s process. A supervisor nurse came in not happy with my wanting to do my own insulin and was worried about liability. I didn’t think to tell her that I would sign something. They were actually less liable by letting me do it than those bozo’s touching my insulin! I did tell the doctor the next day but in the future, I want to make sure I have something handy – you aren’t always thinking straight when you are sick.
I too when I was hospitalized have always managed my Diabetes. As you said they have no idea what it takes to manage our disease. They don't know that we are all different and not like stamped out cookies. You made a wise decision and on some level I know some appreciated what you did. The few times I've made that decision the nurses appreciated what I was doing and told others who treated me as a novelity. At times they would come in and tell me how they wished some of their Diabetes patients were as informed about their disease as I am.
Nice! I keep meaning to tell my local doctor as well as my cardiologist that if I'm ever hospitalized they tell the staff to allow me to manage my own diabetes.
I must be lucky. Every time I've been in the hospital (emergency or admitted) I've been able to manage my own diabetes. I've also always been accompanied by one of my parents, though. It would be interesting to see if I got the same treatment if I showed up alone.
