Diabetic Lawyer/Cop/Medic/Nurse question

We do not do it on any general patient floors in any facility I work. We allow blood sugars to raise to about 150 in certain critical patients until fluid, electrolye, acid base balance have stablized because critical patient have an increased utilization of glucose and all stores have been used causing hypoglycemia which causes fluid, electrolye, acid base balance to become more unstablized. These patients usual need 2 to 3 days to stablized and at that level of their unstability little to no healing is occurring. As stated before most of our acute patients with heart attacks, pneumonia, cellulitis get insulin on a sliding scale to keep them as normal level possible for healing and many of those patients are not diabetic but stressful conditions and infection can cause glucose levels to rise. We do not keep glucose levels elevated just so nurses don’t have to treat lows. and yes sometimes surgery allows elevation during procedures do to patients increase use of glucose stores

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After reading above about the use of dextrose IV bags (D5W) being used with diabetic patients, I realized that there’s more involved to this issue than simply glucose and insulin. In DKA, I understand, electrolyte and acid/base balance are important.

I didn’t mean to indict the integrity of nurses with my comment. I’ve had some unpleasant and unnecessary experience with medical staff who tried to bulldoze me over my personal blood-glucose issue. When it appears that a person who should know, doesn’t know, it undermines credibility.

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I didn’t take it as such, a diabetic and many other disease processes play havoc and what needs to be done to get them back on their feet and back to health isn’t always understandable and in that case the doctors and nurses should explain why they want to do and why. The nurses and doctors I work with try to include the patient in our plan of care. It’s very hard when a large percent of patients don’t take their medications, they don’t follow treatment plans, do don’t do follow ups, and when they are in a bad way it’s our fault and we are stupid. It’s so much fun to be cursed, sprit on, struck and screamed at for something that’s their doing and not mine. The endo system is a bear to care for because it runs the whole body systems in one way or another. These for your great input you are full of knowledge.

And so does my doc, which is one of the main reasons he is my doc. But I’ve been at this a very long time and for every one of those, I can show you one of the other kind. Think that ratio sounds too high? Well, considering all the doctors I have ever had, the ratio is about 2:1 the wrong way.

Of course conduct like that is reprehensible (and pernicious) wherever and whenever you encounter it, and there is no acceptable excuse.

I’ll tell you what else is no fun, either: being chewed out and/or shouted at (not exaggerating there) when you do precisely as advised but some unexpected physiological glitch leads to divergent or adverse results, and it’s just taken for granted that you didn’t follow directions and must be at fault, because the instructions you received can’t possibly be.

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I see, its like the marathon runners when they drink too much water and their sodium and potassium levels get all goofy and hearts stop? Except, kinda the opposite.

Diabetics behave badly sometimes. Healthcare workers genuinely loathe us. I understand why. But, welcome to ‘sick’ people. Me and my Doc had a nice talk about how Versed makes us both freak the f out. She was so cute and foreign sounding - she said she thought all the nurses were ‘witches.’ Hehehe, my Doc has a deep seeded, subliminal fear of ‘witches’ during bad trips from Versed. Its cute. But, she’s only 100 lbs.

I’m 170 lbs of Nordic, ripped steel. I could do some damage to some health care providers. Its not ‘cute’ for me to have the freak outs.

As soon as I’m conscious, I gotta get to my safe house filled with giant Ukrainians who can defend themselves. I will sit in the sunshine in the lawn. They will feed me and give me cigarettes until I recover my wits. Local PD isn’t coming over there to get me. But, if my chronic illness goon squad has to show up at the hospital, they are taking me with them…or someone’s going to jail… That plan is not ideal. One of those guys lived through Chernobyl, he is not afraid of Doctors and has medical problems none of us even understand. Most of them hate being inside the hospital WAY more than me. At some point it becomes dangerous for the providers AND the pt. Maybe we all have hospital ptsd. I just don’t know. You guys heard this episode? Maybe having multiple chronic illnesses makes me WAY more afraid of the hospital than the average diabetic. I didn’t realize that.

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If you wind up in the endocrinology wing of your hospital, you are likely to get much better management of your diabetes than if you wind up in nephrology or orthopedics, where the doctors assume that because your case falls within their area of expertise in one field that means they should also manage your diabetes.

I have had a hard time in the past. I was hospitalized for something else and I was in the hospital a long time. My BG was always high. I was transferred to another unit. A doctor in charge of me stated that he “could get my BG down and that was not a problem.” I never saw the doctor again but I did pass out the next day because the nurse wanted me to wait for the meal tray. How can a doctor think he can control my BG that easily?
I felt like a sitting duck being in the hospital with Type 1 diabetes. I still have a lot of pain thinking about this situation. I can’t change being a Type I and I can’t change hospital policy. This was hard.
Once I had passed out and my friend took me to the ER. I was coming to when I heard two things- BG 130 and the doctor ordering that I get a shot of glucose. I went up to 500 that day after leaving the hospital. I had to go to work this way. It was upsetting.
I have had this type of thing done enough to know that there is nothing I can do to insure that this won’t happen again. I am actually afraid of hospitals, especially the ER.
I’m scared. Is anyone else scared?. I have a hard time controlling my BG as it is, then being ill causes problems, then this with the hospital and diabetes
.
I have chosen to accept that this is the way that it is in my area and that trying to fight about it is not conducive to getting the right help. I have also choose to be nice and try to cooperate because it is more likely to result in a positive outcome.
I don’t want people to end up hating treating people with diabetes. There is a lot less stress this way. It wasn’t easy to come to this conclusion but I think it is the safest way.

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Ok. So a funny story.

We went to the hospital for something. I don’t recall. This is of course years after the T1 diagnosis. Local hospital - didn’t think it necessary to make the cross-country trip for the good one (ok - maybe little exaggeration - lol). So anyway we are there for like 8~10 hours or however long some of these ER trips take. Waiting, running tests, this doc, that doc, few more tests, waiting, etc…

Finally we get the diagnosis. Surprise - you are T1 !!!

We look at each other. Politely nod to the Doc and say we will follow-up with our primary. Sign the forms and Beat Feet.

Lesson learned.

All Hospitals are not the same. All ERs are not the same. All Medical Teams are not the same. Some REALLY are better than others.

The Children’s Hospital we go to and the Medical Teams they provide are outstanding. One would assume they pull in all the top talent from the greater area.

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Medical teams ARE all different. It’s a fairly complex system. Difficult to predict the result.

What I have learned from this post is that my question is WAY more of an epilepsy question. It’s all over the epilepsy forums…‘legal this,’ and ‘legal that.’ They know this off the top of their heads and will have practical experience with it. I identify more as a diabetic because seizures are relatively uncommon for me. But, I’m going to go over to their forums and report back because they might touch on some of the issues raised here. I’ll let you know what I find. I’ll let you know what they are like over there. Curious. They will be different that us in some ways. Their website and my junk operating system are fighting, so it might take a couple days. @Tim35, the epileptics get cyber attacked more than the diabetics do, I think. I think they will be less data driven, more mystical, individuals with less opportunity for control over their system and thus prone to more catastrophic failures. They are the ‘painters’ of chronic illness, we are the ‘measurers’.

Dear Diabetics,

I spoke with a saint today. Those epileptics are sure ‘lawyered up.’ I wonder if that’s because they have a history of being sterilized and locked up and burned at the stake. I will investigate their secret knowledge of escaping the hospital. Some of them are real ‘frequent flyers.’ They know things.

They said that I might not be able to do what I am trying to do, but they are looking into it. I realize that my request ranges from perfectly reasonable, to a gross violation of medical protocol, depending on the circumstances, and the provider.

I explained to them that Diabetics sometimes complain about how our diabetes is managed in hospital. There was knowing laughter because, apparently, epileptics also have similar complaints about that. That seemed to interest them.

For the record, they have over 40 patron saints of their illness, and we only have 2. I guess we died in the olden days.

image

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As reported in his ‘Table Talk,’ Martin Luther was once asked what to do with a 13-year-old boy who was rapidly losing weight despite eating well, voiding enormous amounts of urine, and terribly thirsty and weak. Luther said that if any living thing could eat and drink that much while still losing weight and remaining thirsty, it was contrary to all the rules of nature and so must be a creature of the Devil. His recommendation was to kill the boy. So it seems diabetics have been getting a bad deal from religion for a long time.

Would it be asking too much for a quote?

Darn. Hospital interception. She spoke with their lawyers and I think their medical people. They say that I can’t be telling the hospital when to release me. Boo, Hiss! Although she did recommend digital med tags that contain my entire medical record. Good idea.

I read Luther’s ‘Tischreden’ many years ago, and while I clearly remember being surprised by that passage which is definitely dealing with a young diabetic, I have not been able to find it since. The problem is that even though some editions of the ‘Table Talk’ have an index, because the original author of the book knew nothing about diabetes, and the index-makers of the book didn’t know how to identify this curious case as what it really was, there is no way to find it beyond re-reading the whole thing. An index for a book by Luther is full of entries like ‘predestination,’ ‘rituals,’ ‘forgiveness of sins,’ ‘indulgences,’ etc., but there’s no entry for ‘diabetes.’

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Got it.
So no quote.

This is the only thing I can find and it’s definitely not about a diabetic:

In Dessau there was a twelve-year-old boy like this: he devoured as much as four farmers did, and he did nothing else than eat and excrete. Luther suggested that he be suffocated. Somebody asked, “For what reason?” He [Luther] replied, “Because I think he’s simply a mass of flesh without a soul. Couldn’t the devil have done this, inasmuch as he gives such shape to the body and mind even of those who have reason that in their obsession they hear, see, and feel nothing? The devil is himself their soul.

https://www.independentliving.org/docs7/miles2005b.html#boy

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Sounds exactly like a new onset type 1 diabetic to me, the main symptoms of which are polyphagia (eating as much as four farmers) and polyuria (does nothing else … but excrete), with an onset at puberty (twelve years old). Thanks for finding it. I had read it in German (my first language) about 30 years ago, but it still stuck in my mind.

Completely agree.

Any connection anybody may try to make to diabetes would be fictional and certainly attributed to the actual text.

Nice job on the leg work !!!

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Any chance of getting this in writing (and sharing such) from the Hospital Lawyer? It would quite interesting to see their legal reasoning.

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The machiavellian part of me would be prone to say, “I’m leaving. If you stop me, I’m not paying the bill.” :sunglasses: