My only experience with hospitals and BGs is when I went into a coma last September, and I was in critical condition. My kidneys had shut down and my BP was 73/52. If my kidneys hadn’t started working again on their own, they were going to put me in the ICU on dialysis.
What bothers me the most is that they seem to have distinct Type 1 and Type 2 protocols, and the Type 2 protocol is not to give insulin unless it is needed to correct a high before a meal. Well, I would go high 2 hours after a meal, and stay there, and they wouldn’t correct for the high until the next meal, but NOT cover the meal, so, of course, I would go right back up again. I laid for hours with BGs in the 400’s and there was no help for it. The CDE finally told them I was a Type 1, and that I needed a basal, and coverage for meals.
Then, without really normalizing my BGs, they sent me to a nursing home, where they did the same thing – Type 2 protocol. I suffered for 3 days (it was a weekend) until I could corner the hospitalist, and get him to put me on a semi-appropriate regimen – they still didn’t know how to handle Type 1’s, but it was better than nothing. (MInd you, I’m not a classic Type 1, but I’ve had 2 CDEs in different places and at different times, tell me that in medical matters, to tell them I’m Type 1, and not sweat the details).
What really scares me is that a diabetic’s BGs, even when the person is in critical condition, can be extremely high, and there is no way that syrup blood can possibly be good for them.
CORRECTION:
This article, published originally on February 14, inaccurately characterized guidelines from the American College of Physicians as applying simply to glucose control in hospitalized patients when the guidelines, in fact, applied to intensive glucose control. We have corrected the article and republish it here in its entirety. Add Your Knowledge comments posted before February 16 were submitted before the corrections were made.
It still doesn’t make sense to me, there’s not exactly a ‘consensus’ in the summary. The other thing is the hypoglycemia doesn’t occur in a vacuum? It takes input and activity to change BG. What was the patient and/or hospital doing in the cases where people died b/c of hypoglycemia and what did the hospital staff do to fix it? Intensive insulin should not be in a vacuum either as testing would be an important part of that.
Looking for ‘gain’ in patients who have T1 diabetes (or T2 on insulin) and are in the ICU for something else seems a little bit absurd? I’m not looking to have them improve my A1C but I don’t want them to double it either. It’s like the test ought to be looking to maintain a relatively stable BG, like the 120-180 doc. She gets it.
If you like to misread my remark please do so. Read in context my point is valid. They just look at survival rates. Can it get more narrow minded? Are the asked diabetologists comfortable with this guideline? No, they call it conservative and not unexpected from the parties involved.
I know what I have endured 20 years ago in ICU and hospitalized. This guideline will make it harder to get proper treatment. They do not even need to try to achieve better control because it is not recommended. One week with numbers higher than 300 can be the tipping point for complications. We are all riding at a close edge to irreversible complications. Seen from this perspective I can not take this guideline lightly.
When people died of hypos…honestly the hospital staff was probably doing nothing for that patient because they had more ‘pressing’ things to do.
I was once in an ICU ward specifically for diabetics. Around 2am I woke up feeling low. I had to call for a nurse for 40 minutes before anyone responded in any way. Then the nurse had to leave to get the glucometer. Then she had to leave to get me a snack. We could have caught the low around 70. But instead when I finally was tested I was in the 40s. By the time I ate I was probably close to unconsciousness.
The staff KNOW they can’t respond in a timely manner, so they dont’ want to deal with hypos as a ‘repercussion’ of intensive (or even average) glucose control.
This was definitely my experience after diagnosis…as my BG screamed downward (the trend), my hands would sting and tingle…like they were asleep. My diabetes wasn’t as long standing or untreated, and my pain certainly wasn’t 4-6 weeks long, but it defiitely hurt intermittently. Took me awhile to figure out why it was happening…
It would be so easy to leave a stash of glucose tablets on the patients bed-table and let them treat themselves!!
It works both ways: I was left to sit at 388 for 4 hours, because the nurse wouldn’t give me any insulin until it was time for the next meal. Protocols, you know. This went on for 3 days because it was a weekend, and I didn’t get it fixed until I literally CORNERED the hospitalist and insisted that I was being treated inappropriately.
My advice: if you are diabetic, and particularly if you are Type 1, DO NOT let yourself get stuck in a hospital!!
