Hospitalization used as an opportunity to complete basal testing

by n1iwr on June 17, 2014

Every now and then, my “new normal”, the results of having had a total pancreatectomy, rises up and makes themselves the center of my attention. I occasionally experience significant abdominal pain, nausea and vomiting, but after a few days inpatient, my symptoms subside & I can resume my daily life activities in my own home. I also need to use jejunostomy tube feeding (to supplement what I am able to eat by mouth) every night. When I’m having a flare of my worst symptoms, I cannot infuse my tube feeding nor can I eat anything orally. So, this usually requires that I get admitted to my local teaching hospital for what I call a “tune up”. This means I get IV fluids and medications to alleviate my symptoms until they back off and let me resume my life.

As one can imagine, I dislike being in the hospital. The smells, becoming dependent on the nurse of the day for all your care and for her/him to communicate for you to the doctor. And, in today’s medical world, I’m never admitted to my own doctor because they now have what’s called a hospitalist whose job it is to care for folks like me in the hospital. They don’t see people outpatient in an office because their office is the hospital floors. Kind of like the TV character, House, MD. So, not only am I feeling like crap, I then have to relay my story to this new person whom I don’t know and she/he doesn’t know me AT ALL. So that fact lends itself to all kinds of anxiety, like, will she/he really understand what is going on with me. And, usually 9 times out of 10, the hospitalist tries to reinvent the wheel, meaning I have to repeat medications I’ve already tried because this new doctor thinks his way will be more successful than the last doctor’s way. And I have had to repeat diagnostic testing more times than I can count because if you tick off a doctor by telling her/him no, that brings up a whole set of problems I don’t have the time nor the inclination to get into. That’s a whole other topic to post about. Suffice it to say, I try to play nice with the new hospitalist no matter how much of an a$$ she/he is.

During a recent admission, I had the pleasure of being cared for by my own endo and his nurse practitioner. For some reason, my admission coincided with their on call schedule. I was delighted, to say the least, as I was having a difficult time with (according to my Dexcom Studio software) spending 75-80% of the day higher than my target range. Which means I was feeling like crap 75-80% of the time. So, we used this admission as a glorified basal testing grounds. I was taking nothing by mouth and my tube feeding were being held until my symptoms resolved, so I was going to be able to see what my BG’s did all by themselves without the added food.

I kept detailed BG records (what else did I have to do?! Did I mention I don’t enjoy day time television? OK, truth be told, I’m a sucker for “Kelly and Michael” but that’s it I swear!! Oh no, wait! Kind of enjoy “Kathy Lee and Hoda” but nothing else. Hmmmm, seems I forgot to mention the “Chew”. What?? I’m trying to learn how to cook but, this time I pinky swear, nothing else. I was too busy recording blood sugars!! But I digress.) I welcomed a purpose to my admission, especially if it was going to help me on the outside, as well as, help me feel better day to day. My NP, CDE (nurse practitioner and certified diabetic educator) came by usually at the end of the day and we reviewed my logs. We discovered I need to add a second basal at night for both scenarios of when I’m infusing and the nights I don’t. My basal, or continuous insulin needs are different at different times of the day, which is a very common scenario. During the day I need a higher rate than on the nights I don’t infuse (usually because I’m having a problem with abdominal pain, nausea and vomiting) and on the nights I do infuse, I need a higher rate than I even need during the day due to the increased continuous infusion of carbs (carbohydrates). We slowly tweaked the rates increasing from my old settings by 0.025 units of insulin per hour at the different times of each day and finally came up with my new rates. I’m happy to say that so far, so good!! I know it’s only been a couple of days but already my BG’s are trending within my target range!! Woo Hoo!! Take that, diabetes!!

I have to say that I’ve been able to make such small increments in my insulin doses thanks to one of the triplets of my D technology…my Medtronics 530 G insulin pump, named Daisy ( the other two being my Dexcom and my BG meter). This never would have been possible when I was on MDI (multiple daily injections). So, I’m, as always, grateful to have access to this amazing D technology!!

I’m usually a positive type of person but being admitted to the hospital with pain especially is no fun, so I was happy to be distracted a little from my symptoms by trying to figure out how to decrease these persistent highs I had been having. Generally, I HATE keeping written logs!! I rely heavily on Carelink & Dexcom Studio to interpret my data and keep me from going nuts trying to record everything while at the same time, trying to live life. This admission gave me the opportunity to keep very a very accurate log and help myself obtain better BG control.

Do you hate to keep logs as much as I do?? Do you regularly use the software for your D technology to keep track of patterns and trends? Any tips on how I could become a better log keeper, especially when it comes to food logs? Along with laundry, they are the bane of my existence!

And, Remember, CHECK…DON’T GUESS!!

the only time i guess before i test bg is when i can't see so i take glucose then test

very low bg affects my eyes

I'm sorry you had to be in hospital, at least that's good that you were able to test the basal with detailed help and figure out specifically what you need as much as possible as well as distract yourself from that. I agree with the hospital system, they all mostly have not very good docs in charge of the case who have not much idea of what is going on with you specifically which is scary.

I often treat lows without testing too. I use the ibg star app with the meter to keep detailed logs of insulin, food/carbs, activity etc. You can make detailed logs and look at it on your phone(iphone required). I think the app is free, so you can just use it without the meter and use your regular meter but you have to then add the bg in manually which takes more time but which is still a lot easier than a written log etc. and less time consuming especially if you use siri to add tags etc. Then you have all your records there on your phone to look at whenever you like including graphs, statistics with average bg, standard deviation and so on. I don't log specific food anymore, just carbs, because I usually eat similar things each day, but you can do that in the ibg star app also.These can be emailed to your doctor/yourself for printing.

Thanks Meee for your comment and for reading my blog! I was very lucky to be able to be well enough to participate in the basal testing. And, you're right! It was a BIG distraction from the monotony of being stuck in the hospital, so I was glad to have something to do, even if it was logging BG's!! LOL!!

Oh my, Sandy. This resonated with me on many different levels....In terms of The D: I'm not insulin dependent yet and not taking any meds yet (I was one of the few lucky T2s whose Doc caught it early), so when I was in that torture chamber called a hospital for a knee replacement, I was innocently at the mercy of kindly, but very "knowledge-limited" nurses.

All they saw was that I was diabetic (Type didn't matter). I couldn't keep food down post-op and got "the shakeys"---because of my 15 years worth of Fibromyalgia which mimics hypoglycemia. They got a BS reading of 69 and pumped me full of unnecessary insulin when all I needed was some string cheese or unsweetened peanut butter. All they had was skippy with it's sugars so I spiked to 200. I realize that # reads differently for you and me, but in 7 years, I had never had a reading over 130. So I was pissed and freaked.....

I try always to take a patient, educational tone in such circumstances (I WAS a teacher for a gazillion years), but I admit I lost it. (I also got no sleep because my cellmate went into crisis and was surrounded by docs and family all night).

My current plan is to never go near a hospital again until I am at death's door when maybe I won't notice or care what the h**l they do with me.

On a much more fun note: Waay back in 2006, I had to have a full-blown, medically necessary hysterectomy. I was still a smoker and got scared about that, so started the Countdown Method a couple months in advance---you know, 1 less ciggie every few days. Went from a pack-and-a-half/day to 5/day. Fine. But what was truly waaay cool, was that by the time I went home after 10 days in the hospital, I had no cravings---I even had stashed a few cigs in the glove box just in case. Didn't want them!

Of course, I never feel like I can suggest this method of quitting to those good folks who are trying---replacing one drug with a whole bunch of them? It worked for me, but I really shouldn't advise it!...LOL....

Sorry for the lengthy trip down memory lane. But thank you, too!.....Blessings...Judith in Portland