Insulin at the hospital

#1

So, @Stang777 brought up a very interesting point. It was something that never occurred to me before…

Have you ever ended up at the hospital (post diagnosis) and been refused insulin? How high was your BG allowed to get before they provided treatment via insulin. Just curious. Is there a specific number where they feel obligated to give you insulin?

@Stang777’s original post:
“My copay for an ER visit is a lot higher than what I pay for many months worth of insulin. I could get about 6 months worth of insulin for one ER copay. Also, before I was diagnosed, an urgent care center sent me to the ER saying my blood sugar level was so high I was about to go into a coma. I went to the ER, one that is a highly regarded one in big city, and all they did was monitor me for most of the day, gave me an IV and monitored my heart, but said they do not treat high blood sugar so they gave me nothing to bring down my level. They sent me home at 2 am on a Saturday night with no instructions other than to get with a primary care doc, who I told them I did not have. They gave me no advice on how to eat or any advice whatsoever as to how to treat my high blood sugar. When I finally got into a doc, when she she saw my test results from the hospital, she said I was extremely close to being in DKA at the hospital, yet they didn’t give me insulin, never mentioned insulin and just sent me home. Had my husband not been one with type 2 who had an understanding of what not to eat in order to keep blood sugar levels down, I probably would have died before I could get into a doc, thanks to the ER at the major hospital here not treating high blood sugar levels and sending me home.”

#2

I don’t have an answer to the questions in your post but I worry about my glucose management in the hospital. Doctors and nurses are overly-fearful about hypoglycemia and would much prefer your blood sugars to be on the hyper end of the scale.

Did you know that hospital professionals have a name for deliberate and intentional high glucose levels? They call it “permissive hyperglycemia”! In the age of hospital “super-bugs,” I find this attitude offensive and possibly life threatening.

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#3

I have never had to go to the hospital for my diabetes, so I have no idea what would happen then, but when I have had surgery I just keep my insulins and give what insulin I think is necessary to stay in good control. I haven’t had to argue with anyone about this. I do turn over control during surgery, but certainly discuss my needs before the surgery. I never let them hook me up with a glucose drip when I am awake.

I haven’t been in a hospital for anything more than lab tests in 9 yrs, so I don’t know if handling my own insulin needs would be any more difficult now. Once they had in my records that I took 100 units of fast acting insulin before meals. At the time that should have read 1 unit. So glad that I wasn’t unconscious.

Why would a hospital refuse to give insulin to a diabetic patient? Am I missing something?

#4

Last Memorial Day a virus causing diarrhea and vomiting resulted in dehydration. The combination raised my BG to “over 600” on my meter. When I got to the ER, my BG was “over 1000” and I was diagnosed with ketoacidosis, renal failure and a hearattack. Obviously, they removed my pump.

Following a heart cathertezation procedure, which thankfully showed no blockages, I was recovering in the hospital. The night “nurse” tested my BG which revealed my BG at 435. When I asked for insulin, I was ignored. Same response two hours later; however, when I insisted on seeing the night nurse, I was advised that she needed to call the doctor. When she couldn’t reach the doctor, she reluctantly agreed to give me 10 units until the doctor could see me in the morning. I was never under 255 while in the hospital.

#5

I’ve read many reports like yours, @Don1942. It raises what I see as a rational concern about managing diabetes in the hospital.

It amazes me that traditional medical practitioners, on one hand, readily hand off responsibility of insulin dosing to the patient 24/7 following diagnosis, but on the other hand dismiss this deep experience gained from that experience but instead dictatorially remove that ability and insist that we accept an amateurish and incompetent dosing system delivered by “experts.”

While I realize that hospital professionals must step in if we are unconscious or otherwise impaired, I don’t think they should ignore the insulin-using patient’s judgment when that patient is cognitively and physically capable.

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#6

I had an intestinal blockage over 3 years ago and was hospitalized because of needing emergency surgery. My hospital uses hospitalists for doing inpatient care. My blood sugar was in the 200-300’s which is high for me. They kept it in the 200’s the whole time I was hospitalized. They also didn’t give me several of my prescribed medications some of which gave me withdrawal symptoms. They did give me insulin but it wasn’t as much I needed. Later I developed three hernias because of the surgery not healing properly. I asked my surgeon why it happened. One was because staples don’t heal as well as stitches and secondly was because of diabetes. I ended up needing surgery again and I wouldn’t agree to staying overnight unless they continued my prescribed medication at the proper doseage. The surgeon also used stitches to prevent any incision healing issues.

I did voice my concerns to the endocrinologist about the hospital not keeping my blood sugar under better control while there. Since then She has spent multiple hours educating doctors in the local area. I hope it helped.

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#7

Welcome to TuDiabetes, @Susie9. I’m sorry you had to go through that. It’s my understanding that healing requires good glucose control. This fact should figure prominently into any medical plan for patients. Before I was diagnosed, I watched a simple skin abrasion take weeks to heal. I’m sure my blood sugar was chronically high.

Good for your doctor for taking your criticism and turning it into constructive action. That’s one of the ways this will get better.

#8

Why I bring it up…

Someone said something insightful on a separate thread.

I think this is the best summary of hospital protocol that I have ever heard, but was never able to put it into words, myself, so clearly and concisely.

Hospitals dont treat highs. Either they feel unqualified to do so or it does not interest them.

I feel like, as a diabetic, my relationship with the hospital is kinda necessary, but its also unhealthy and destructive. There doesn’t seem to be any way to change it. Might as well be this song by James. Its so rigid and neurotic. Its maddening. I wish I could sign something that just says, “I dont do biz w/ the hospital. If I die, I die.” If I could somehow just cut my losses and move on…but, not even that is possible.

#9

I just take my insulin with me and treat myself. Maybe everybody should have some bottles and syringes so that they can take them in with them. I have never had anyone search my purse or body. Also very good to always have a loved one or very close friend with you if possible. Even when I was taken by ambulance, for emergency heart stents to a large hospital, I used my own insulin. I can only think of one doctor who would not have supported me doing this, and I soon dropped her.

But again, I haven’t been to a hospital for reasons related to diabetes since 1959, and I have never been in an accident.

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#10

I think thats a practical solution and good practice. But, at the same time, it can get trickier than that. For instance, I have had Doctors say that if they caught anyone with insulin in the hospital room, my family wouldn’t be allowed to see me. They aren’t always fans of self-administration of medication. But, they, themselves, refuse to administer.

I propose a number. That number is 300. If BG > 300, then they ought to have to treat. Especially, if your there for many days.

I think thats a fair compromise for a number. I don’t like it. They might not like it,its a reasonable goal, even for a novice insulin prescriber. That seems like a goal that could be reasonably be met.

Although, they would have to give a lot of IV fluids at 300, over time. Maybe thats still too high. Risk of infections would be high, which is not what you want in a hospital environment.

Refusing someone insulin seems awful close to a formal definition of “doing harm.”

#11

I would edit this to read that medical professionals who routinely refuse insulin to a hospitalized diabetic patient does them harm.

Regarding your suggestion to use 300 mg/dL (16.7 mmol/L) as an action threshold, I would agree if the number was 180 (10).

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#12

Could we invent some kinda volunteer diabetic organization that administers insulin in the hospital? I mean, since diabetics seem to be the only ones qualified to do it. People could sign an agreement, and when needed, could show up to provide care. I know thats getting kinda crazy, but I’m just brainstorming.

#13

Do you think they are capable of 180 without killing you? They are so insulin shy, that I’m not sure. I mean, I think they are genuinely afraid to administer insulin. Although, 180 gives them a nice error range of 100 points. Its not ridiculous.

#14

That 180 (10) threshold would work if it was coupled by an aggressive glucose monitoring (fingerstick) schedule, especially at the time when any correction dose is peaking.

#15

Why dont they have Dexcoms? I think hourly finger sticks would certainly enable them to safely aim for a 180 baseline. Its primitive, but its cheap. Your right. I’m being too easy on them. Perhaps a nice round number of 200 is easier for them to remember. That would certainly decrease incidence of infection and mortality. Perhaps, they dont even need to administer IV fluids at that.

If they are bad at the bolus, post-meals might hit 400. But, even that might enable us to eat a sandwich while there…if they provide correction. It would be unpleasant, but better than it is now. Baby steps.

#16

I see the first requirement to dose insulin well is to get over the fear. I think most medical practitioners are afraid of insulin. This fear clouds and skews their judgments about insulin dosing, much to the detriment of the patient. This fear also gets in the way of their gaining competence.

This whole issue would go better, in part, if they listened to at least some of their patients.

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#17

At one of the clinical trial center I work with, they are actually trying to do a study with this. They want to see how well using CGMS help with outcomes and how it helps the nursing staff.
I will say the last time I was in overnight “observation “, they wanted to remove my pump. And I told them, their was no way it was coming off. So I literally had to sign a number of forms and I had to let them know everything I was doing. No problem and I must say, they wanted my blood sugar around 150 before starting the stress/echo test and with all my equipment still attached, no problem.

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#18

If they tested my BG every two hours, it consistently remained over 430, and they had no interest in treating my extreme hypoglycemia, why were they testing every two hours.

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#19

My guess is that they were carefully observing a standard of care. They served the letter of the standard but didn’t serve the spirit. Standards of care have a dark side in that they wrongfully absolve responsibility even if it leads to a poor and an easily predicted outcome.

#20

Geez, what kind of care providers do you guys have to suffer through??

I will say that I have found that the /types/ of insulin found in the hospital pharmacies are pretty outdated. When I was admitted for DKA in 2013 (many years after my diagnosis), the only insulin they actually had in the hospital was Regular. I was still cruising in the 200’s when I finally left.

And last year for my c-section, the nurses were all too happy to allow me to manage my own blood sugar and insulin requirements since things were changing so quickly postpartum. I had to speak with the head nurse and then the hospitalists came in to speak with me, but the attitude was “You know what you’re doing, we don’t see any reason to be involved, keep on doing it.” The nurses just asked me what my sugar was each time they came in for bp checks and a quick check of my Dexcom was all that was needed.

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