Had a minor procedure done under anesthesia at the hospital earlier today (nothing to do with D). I had been fasting, and therefore taking no insulin since lunch yesterday-- as I take no long acting, this is no big deal for me. I tested my fasting glucose level this morning-- 97-- perfect. The prep nurse recorded this number in my chart. Upon waking up after the procedure (4 hours after the fasting test, without any food or insulin since), the recovery nurse was telling me I needed to have a milkshake right away becasue my glucose levels were low. I was still groggy and had no idea what she was talking about. Had they tested me while I was under? How could I possibly be low? Luckily my wife, a nurse, was right there with me. No-- they had not tested me. No, I was not low.
Apparantly the hospital nurse thought that because my fasting level was 97, 4 hours prior, the first order of business upon waking was to slam a milkshake down a type 1 diabetics throat without any bolus.
I'm glad I immediately realized how ridiculous this was and of course didn't eat anything at that time-- but what if I had been a little kid or an older person who wan't thinking as fast as they used to? Pretty ridiculous.
Went home and tested at 110 before bolusing and eating. I didn't opt for the milkshake.
It is always like that. I have created quick reference cards (I am an adult educator, so I apologize for the language, but you understand... ;) and provide them to docs and dentists, etc. before all procedures. It includes pump and CGM instructions. recent A1Cs, last few readings, etc. All they are worried about is you being at a low blood glucose level and suing them. If you leave at 250, no biggie for them. But if you are crashing at 40 and they let you go....
Reality..I have been a type 1 a long time. I would have never gone into a sleep induced state at 97 (which is a great reading.) You lose all control under anesthetic, and you can correct to lower it later, but if it falls it is not good. Eating something would not have caused big, long term damage and might have been a salvation if you had crashed later in the day. Which is always a possibility with the drugs used.
I am very careful with the very few surgical procedures I have had. The drugs they use can get you big time later in the day. Be flexible and understand that the hospital staff are not diabetic and it is not a top on their list of importance. PLUS, to them 97 is low..
I agree that if I was taking any insulin 97 wouldn’t be a good level to go under at… But as I hadn’t taken any rapid insulin in about 20 hours, there was no reason to even consider lows…
Sometimes trauma, including surgery, can spike BG, even if you are knocked out. I was really flat during an umbilical hernia repair with "suprises" (5" scar instead of arthroscopic 1/2" scar...I like scars though...) but I let things ride and had like .3U CB "on board" when they blasted off as turning my basal way down involved a presurgery spike. I had a bunch of food lined up afterwards but the anesthetic seemed to fry my taste buds so I ended up not eating that much and just chilling out. I think the important thing is to test before you listen to medical experts like your milkshake buddy!
If hospital staff are that worried about hypoglycemia then why don't they just to commit to doing a regular series of BG tests (every 15 minutes if necessary) to assuage their concern? Deliberately driving a patient into hyperglycemia just so they don't have to worry is not defensible.
Hospital staff and medical professionals owe us a reasonable standard of medical care, not one that places us in hyperglycemia for hours on end following surgery. Normal blood sugar helps us to heal, an important post surgery factor.
This would have irritated me too. Glad your wife was there to put a stop to that nonsense. I hope that the hospital staff learned something from your situation.
Many years ago, I was transported by ambulance due to injecting regular insulin at night instead of long acting insulin. When I got to the hospital the sugar emergency was over as the paramedics had started an IV dextrose drip. I was conscious when I arrived at the ER. The ER staff encouraged me to drink juice and eat some cereal and milk. The combination of the severe hypo and the ER food drove me well over 300 and it took 24 hours to get my BG under control. I learned then that I know more about diabetes than most medical professionals.
My experiences have always been very good. They have always tested me during surgery, and coming out of surgery too. I've never had a nurse have me drink a regular soda or juice or anything without testing first. There's a lot of things I don't particularly like about VA, but I do have to say we have really good hospitals and knock on wood I have never had a bad experience.
A real significant low? Or something like 60? I've never had a real noteworthy low without insulin playing a role in it-- I've had numbers in the 60s after long periods of exercise with no insluin... and once I got a little carried away with the buddies and had a few too many drinks and woke up at about 60 without insulin.. but never any anything dangerously low without insulin
I saw from your profile that you are only about a year into your diagnosis Shawnmarie. Is it possible you could still be honeymooning? I don't recall ever having a honeymoon to speak of, I dont know if my poor pancreas was just fried after diagnosis, or maybe it just has something to do with them older pork/beef insulins??? Having lows without insulin might be possible if you were still honeymooning, that can throw a lot of stuff off, or perhaps your I:C ratio is a bit off? I too have never had any significant low with no active rapid acting in my system.
Wish I could say, no... that I'd never encountered such scathing incompetence.... among my personal favorites incidents (among others)
being told quite seriously it was the boiled GREEN BEANS which I had not eaten at lunch which caused the severe low episode, and not the excess insulin they had put directly into my saline IV line which took me out....
or decades later
Between 500-600 bghgl for several hours the "hospitalist" (moron- in charge) changed my insulin. LOWERING it, reducing it by 50% AND refused to use any short acting to correct the extreme high situation... all without saying anything to me.
Suffice to say they were not pleased when I was through with them. But they were accredited by the state, supposedly medical doctors.
I ask you know what you call a doctor/nurse who graduated at the BOTTOM of their class(es)....
I'm a nightmare patient lol being that I work in healthcare, I let them know right up from I'm a nurse. LOL so don't argue with me, I'm a nurse PLUS diabetic for close to 30 years. But all joking aside our hospitals here and our doctors/nurses are really pretty good about checking blood glucose levels frequently, and our doctors really get on them for letting blood glucose levels get high.
I've never had any problems with being in the hospital if I didn't have my meter, paging the nurse and saying I feel a little low, and her TESTING my blood glucose levels BEFORE treating, and they've always been really good with what can I get you. And testing pretty frequently to make sure you are coming up and IF I felt I needed additional (soda, juice whatever being able to get it, but as long as I was making sense, and coherent and not symptomatic and about to pass out, they've always let me be in control. Maybe like I said, it helps since I am a nurse, but I've seen working in the hospitals other diabetic patients, where its test and treat, not just blindly dump a bunch of glucose down someone, esp if they aren't symptomatic and making sense.
A milkshake! I've found medical staff to be phobic about lows, for which they could be liable, & not concerned about highs.
When hospitalized with DKA, I was reprimanded for not eating starch laden meals. Somehow pancakes, French toast, grilled cheese sandwiches on thick Texas toast, mashed potatoes, corn & spaghetti were considered diabetic meals because dessert was sugar-free pudding. Get me outta here before they kill me.
A big risk, as Terry mentioned, of being injected with dextrose when admitted to the ER on the assumption diabetics are there for hypogylcemia.
Does anyone know what the third leading cause of death is in the US?
Doctors.
As reported in the Journal of the Medical Association (JAMA),the deaths caused by the diagnosis, manner and treatment of doctors "constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer."
We depend on healthcare professionals, they can really help improve our health and quality of life, but we should never blindly just trust them.
My story is your story christy. Right out of the box," I'm a nurse, T1 for 29 years and don't you dare touch my pump while I'm under anesethia". I find that hospital inpatient providers know little about current T1 management, but for the most part let me or my husband run the show as far as testing, bolusing, etc... I find the lack of knowledge of the bedside nurse scary, but I blame that partially on the movement of taking basic diabetes care away from the bedside to the outpatient area, but also to the "dumbing down" of the bedside nurse, in order to prevent medical errors.
Yes you were fortunate that your wife waa present. I my experiences (too many mostly D related) I found it necessary to discuss the level of awareness of ALL staff theen make sure that I knew what was going on or who was going to oversee my care. Always check the hospitals insulin to carb ration as well as the blood sugar level adjustment procedure.
I agree I mean when I was diagnosed I was in the hospital for at least a week, maybe even a little longer. Of course this was like 1984ish. And you had a specially trained diabetes nurse at the bedside, it was hours of diabetes education, etc. Now you are diagnosed and as long as your are not DKA, its like here's a bottle of insulin, here's a syringe figure it out. It really is scary and I think that is one reason, so many newly diagnosed diabetics are just stumbling around in the dark. I mean Im not saying after a week I knew EVERYTHING, but I was confident even at 10 years old of what I needed to do.
Ugh, this is one of those things that scares me the most - being in a situation where I can't make decisions for myself and having to rely on incompetent hospital personnel. In my experience, hospitals are all skewed to dealing with T2s, and most of the professionals I've encountered in hospitals don't have a clue about T1 and the management it entails. I think there needs to not only be more education within hospitals, but also more of a culture where the patient who lives with the disease 24/7 is listened to. That's what bugs me the most - when they don't listen!
lol.. I'm glad you resisted the milkshake, fortunately your wife was there...
my experience was on my second hospital stay, one day after I was released from the icu, I was told after spending the day in the er and not eating all day that I one- was not going to be given dinner and two- was not going to be given insulin bolus for meals unless my bg was above 140!! This resulted in a big argument which resulted in me being allowed to use my own insulin for bolus and do my own testing- they did my basal doses. I don't think my nurse or anyone there obviously had very much knowledge about D. They just treat everyone the same and allow bg which are way too high obviously... they also gave me some meals which were total carbs before I started selecting them.. they did that my last day in the icu also, my first solid meal was a piece of french toast with syrup, lol.
In an Er where I stayed overnight after that, they came to tell me several hours after my bg tested at 60 according to their from the vein tests, that I needed to drink some juice because my bg was low... lol. I explained that I was testing it myself and it was fine and it was bit late to give me some juice.
Before my late onset type 1 diagnosis, I had mild hypoglycemia and I recorded one reading at 39- it was an older meter so apparently that was really 49. I treated them with tuna and mayo and some bread. Those lows don't feel like my insulin induced lows though. I never felt I would pass out at all etc. Eating something always worked.
Luckily, i havent had to be hospitalized very many times during the 30 years i have had diabetes but i was just in the hospital for a week in October. I did the testing, I calculated the doses and gave my own injections, i kept the log. I had to fuss with the nurses a little about it but they eventually gave in. I have only been put out for one operation but it was only for an hour. I did all the pre and post op testing. My daughter is a nurse and she told me NEVER to let the hospital manage my diabetes.
