Insulin at the hospital

#21

Hyper - They dont treat hyperglycemia.

#22

Maybe if you put a sugary substance on your finger before they pricked it for the test you could make a high enough reading they would have to do something.

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#23

Thats good brainstorming. It would dbe nice to know if there is a number at which they have to do something. I’m guessing theres not.

#24

I was hospitalized for a kidney stone last year and had to fight with patient care manager over whether I was going to get two units to cover a meal or six units. Obviously I wanted the six. She only wanted to let me have two. I dint think my blood sugar ever went under 200 the whole time I was there.

I was never more glad to leave a place.

#25

I was hospitalized twice two years ago and had to fight with several ER docs about if I’d be allowed to keep my pump (Canadian hospital stack their patients for admission in the ER and hallways until ward beds become available). Same thing on the floor upstairs in the ward, plus the charge nurse got her nose out of joint as they don’t like (allow) patients to self-medicate.

Not only did I keep the pump for my entire stay(s), but I also brought in a slew of meds as they weren’t ordering and delivering my script meds in a regular fashion (assortment of BP meds and immuno-suppresants).

I gave in on the oral scripts however kept everything I needed for backup for those times they “forgot” I have time sensitive meds.

The regular nurses had no issues with this, only the specialists who knew nothing about my other disorders.

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#26

Just a personal observation here based on my own recent hospital stays…

If you as a patient in the US at a US hospital go hypo, then that hospital will get fewer reimbursement dollars from Medicare has posted on the internet a variety of metrics that they use when deciding on procedure reimbursement values - hypos are one. The hospitals are hypo - phobic and willing to go hyper to avoid them. Also, even with my chart in hand and specific instructions from my Endo, the hospital staff including the hospitalists were at a loss to do the mental math required to maintain a 120 bg, especially since I was getting fingersticks only 4x daily. The hospital I was in would not recognize my cgm values even though my cgm was in lockstep with fingerstick values.

I worked /lobbyed ahead of time to maintain my own insulin regime, and even though I am a pumper the hospital had to make a special exception for me provided I did not drop below 80 at any point in time. I also had to show that I had good glucose control for 4 weeks prior. I was the test rat. Hopefully another diabetic will have an easier time going forward at that hospital.

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#27

I have always been given insulin. However, they will not allow me to use it in a pump. If I want insulin for my pump I have to bring it. Give me a break. I do not get in the car unless I have insulin, sets and sensors.

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#28

I had a lot of trouble with hospitals, but only after I turned 18 ironically. Before I turned 18, I had the most fantastic pediatric endocrinologist. She was the one who showed up while I was still delirious during diagnosis, and walked me through the process. She even asked my family and I what I wanted to eat after realizing how picky I was, told my dad to go down to the cafeteria and order me a leboulanger ham sandwich, and waited with us to get the insulin order and go over carb counting. When I had dka at 17, she showed up again to give the hospital doctor help, so I was fine.

The times I have been in the hospital as an adult were not so good. At one point, the sugar was so high even the nurse said I needed insulin, went to get the doctor to sign off on it, and didn’t return for 4 hours. I have rarely had a doctor spend more than 5 minutes checking on me in the hospital as an adult, which makes me think they’re seriously understaffed at all times. I just try to avoid the hospital if I can now.

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#29

Hey @El_Ver, I was thinking about you yesterday and meant to message you. The DMV system is all changing for homeland security and enhanced/realID. I feel certain that they are constructing a national database. They want tax records now. I feel certain this will have some kinda negative impact for CA diabetics because you guys have the tightest rules and records might now be able to follow you wherever you go. It gave me the creeps that DMV wants tax forms. Thats more info than they are able to secure responsibly.

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#30

Soooo last year I went to the er one afternoon because my bg was very low at work, and I wasn’t able to raise it myself. While there, they first gave me an IV to raise it, fed me, then kept me overnight for observation.

The next day they admitted me. My bg was now in the 300s, after being fed very rich meals. I said, “hey, I’m on Lantus…” which they did not have at the hospital so of course, my bg got higher & higher. After two days of this nonsense, they wanted to start me on a new med because my numbers were high. “You think?? I’m eating constantly with no insulin. I have a endocrinologist. I’m not starting a new medication.”

So finally, around 10pm on night two, they gave me a fast acting insulin, Humalog I think. I was afraid to take it because I have never been on fast acting insulin, but I could not take my numbers being so high so long. Still, I was in 300s the next day. I was livid. I wanted to sign myself out, and was told if I did that, my insurance would not cover the bill.

I was told in order to be released I had to speak to a diabetes educator. On the third day, one came in talking about how high my numbers were. I argued that, they were high because I could not have insulin. Then I was told lows are more dangerous than highs. I said, “I have had diabetes for 10 yrs. I was told the very first week, not to ever let my numbers be this high, and for this long. When I was diagnosed, my numbers were were high like this. I’m over this and over going to the bathroom every 20 minutes. This is not at all ok. I’m here because 3 days ago I took my insulin and did not eat. It’s my fault. As a result I’ve been held here for three days. I need to go home, take my lantus, and call my own endocrinologist.”

After three days of this drama & complaining I was released. I will have to literally pass out before I go back there again.

I do not understand, how in the world it’s ok to be in the 300s at a hospital?? I have never, ever, been that frustrated.

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#31

@mohe0001 CA DMV has been implementing the Real ID (aka National ID) for the last 18 months or so. They got through their 1st year of issuing the new fancy DLs and found out that they were doing wrong according to Dept Homeland Security.

Personally I opted out of the Real ID program as I currently hold a passport and see no benefit for me to the new ID except possibly convenience when flying. My passport will do everything the Real ID will except allow me to drive. I will take the cheap old school DL for that, lol

#32

This is indefensible. I’d love to hear from working hospital professionals why they think this is OK. I suspect it is because of hospital policies over-responding to their ignorant and fearful attitude towards hypoglycemia. I see this attitude as medical malpractice. It violates medicine’s basic rule: first, do no harm.

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#33

I agree that this is insurance company’s wildly interfering in care. I dont think we can come up with a better example (or more egregious).

@El_Ver, I got a new ID before the requirements hit, but next time you renew, you will be required to do RealID. Just a heads up that its coming down the pipeline. Its some kinda federal requirement. https://www.dhs.gov/real-id

#34

Hakima, I don’t understand why you were admitted after the hypoglycemia was treated.

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#35

Neither do I!! What I was told… overnight for observation. Then the next day I was told after I saw the doctor I could leave. Not. I didn’t see a doctor, but the doctor admitted me based on the nurse saying I first was low, now I am high, and my bg is not stable. I asked to speak to the doctor and was told, they left the building & were on the way to another hospital… at 11 am. I said, can’t they come back here?? And on & on it went. I did ask, how is it I came here for low bg, and now being admitted for high bg? It was crazy.

#36

I need to add, it seemed very …bureaucratic in a way. All these high level people… counselors, educators, dieticians, etc, coming in to discuss diabetes, the effects of low & high blood sugars, handing out brochures, suggesting new medications, trying to give me a treatment plan, etc etc.

So very frustrating. If I passed out right in front of that place I would ask to be taken to another facility.

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#37

What an awful experience Hakima! Yes, stay away from that hospital. How horribly frustrating.

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#38

I think there is hope,

Automated Device Improves Glucose Control in Hospitalized Patients https://jamanetwork.com/journals/jama/article-abstract/2698488

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#39

This all sounds scary! I don’t get that they can’t monitor your blood sugar and keep it under 200 at least in the hospital. None of us want 200 obviously, but they probably could get some set protocol of over 200 give 2 units of insulin you would think. It seems like even 1 unit for every 25 points over 150 would be easy to teach and be okay. That would be a really safe zone to aim for. I guess the best way is to go in with a pump and insist on keeping it. I would also guess take some insulin, them tell them you already took it so they can chart it. I just can’t see being in the hospital and staying at really high levels.

I think this must come down to the medical professionals not being educated enough to treat it, even now. A case in point, I have a new Doctor that is fresh out of medical school within the last 2 years and she panicked over the lows I had and got me into an endo immediately. The endo didn’t panic, saw I was making adjustments, just thought that 95 was too low of a number to aim for. No biggy, I never needed help from anyone.

I do have to say though before I was diagnosed with type 1 I went to urgent care in Calif when my blood sugars hit 450 and they gave me an insulin shot and waited to see it was coming down and then sent me home. It was a doctor that saw me and since then they have switched out the doctors for PA’s, so it could be different now.

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#40

After spending 4 days in the hospital, where I was never below 250 and often above 290, I had to be evaluated by a physical therapist before being released. It was the first time out of bed so I was a bit unsteady asa result, I had to agree to sign up for “walking therapy”.

An hour later, I was allowed to walk out without a wheel chair. In fact, the nurse didn’t accompany me all the way to the door but instead directed me to the exit.