Just to add. Care can really vary on the hospital you go too and what they have decided is their protocol. It’s possible that the protocol can vary with the doctor in charge.
I have been to emergency now a few times because of my back. So I was completely lucid and capable. They knew I was a type 1 diabetic and they had access to my charts. I think my endo has written somewhere I am extremely well controlled because of misc Dr’s comments. not sure. At the ER I think one time I was asked, “you want to take care of your BG control yourself right”? The other times it was never talked about or brought up even though I make sure upon admission I let them know I am a type 1.
For surgeries, this last time in preop waiting to go into surgery, I asked for some insulin and was asked how much insulin do I want and they administered that dose with Novorapid, except during surgery when they decided how much. They followed what I told them. I was fighting a tooth infection so I was using a ridiculous amount of insulin and wasn’t going to delay wrist surgery. I could have taken the pump control with me I suppose as they let me take my phone for the CGM, but I wasn’t trusting it completely as I had been having trouble with insertion sites.
Preop and post op during a surgery prior I just gave myself dosing with my pump and it never came into question. I was at an even level enough they could care less what I was doing and never asked anything specific. I just made sure the anesthesiologist knew prior to surgery I was a type 1 and she said she would keep an eye on it and actually gave me a couple of units during surgery.
I haven’t ever been actually admitted to our hospital here, but I have talked to the diabetic educator who works there and she has said they are pretty good about letting you manage your sugars yourself except if you are admitted for a BG issue like DKA. Then she said they want total care and control.
I understand other folks idea that having one decision maker might be best but I agree with Terry4. He was lucky to have been cognitively and physically well enough to advocate for himself, but much of the medical community that I have observed in a very large metropolitan city is either unfamiliar, unwilling or not versed enough regarding treatment of T1D patients and how to deal with them in an institutional setting. My wife (a T1D) was taken to the ER after suffering a seizure and subsequent fall. She is also suffering from advanced dementia. The ER staff was initially unwilling or unprepared to treat her T1D while they tested for fractures, etc from the fall. They could not keep her calm and considered restraining her but instead finally allowed me into her exam area (this was during early Covid) upon realizing she also needed to be treated for her diabetes. They had two nurses and a volunteer trying to keep her IV in, keep her in bed all the while firing off questions at her. Obviously they were not well prepared to deal with a dementia patient let alone a T1D patient. In the end they decided that the hospital was not properly able to keep her safe and treat her T1D during an overnight stay to observe her in the hospital. They were more than happy to allow me to treat her while she was being evaluated in ER as well as to send her home (after completing their examinations and prescribing for the seizure which landed her there) instead of keeping her for observation. I have no doubt they did their best but they were glad to have me do things for them and in the end their decision was sound and grounded in the reality of the situation. If you look at the NIH studies about institutionalized treating of T1D’s with comorbidities, like dementia and those outcomes - they are not good to put it mildly. Most institutionalized settings don’t have the practical know-how to properly treat T1D in my opinion.
