Insulin at the hospital

#41

Maybe a little insight into their thinking.

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#42

I was hopitalized 18 years ago for a fractured spine from a car accident. My endo visited me a few hours after I was admitted and told the nursing staff to return my pump, test my blood sugar when I requested, share the results, and let me manage the diabetes myself. He’s the best doctor I ever had and recognized I knew better than anyone else how to control my blood sugar.

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#43

@Paytone That’s wonderful! I think my old endo would have been the same way.
We could all hope for it to go that well!

#44

I was actually just in the hospital in February due to a bug leading to severe dehydration. I have a pump…which is probably lucky…because it manages for me. I did have to sign a waiver though that I was treating it myself. They still tested me even though I was doing it and have a CGM and when they found out I was planning to fill my own insulin…we were reminded (because we actually knew, just had a nurse that happened to okay it) that we were NOT to use our own insulin because of safety issues. I was supposed to write down every time I bolused. Yeah…I didn’t.

Yes!

This, too. I don’t understand that when they have a full history.

I was in this range once. They told me I had a virus (which I didn’t) and sent me home. I’ve also been in DKA with sugars in the 100s.

Technically not allowed, at least by the two hospitals we use. I think one of my nurses got in trouble for telling me I could use my own. Yea, we can and have just done it anyway. I also, though, don’t want to risk anything by not sharing that information or breaking a “rule.” For instance…

#45

As long as I told the nurses how much insulin I was injecting they were fine with me using my own insulin, but as I said that was 9 yrs ago.

#46

A different take on BG reading in hospital, based on several recent stays. They don’t have a developed approach as to what to do about BG readings. Typically, you’re not there to be treated for diabetes. In my case, T2 15 yrs, A1c under 7, under control with oral meds, they’d measure BG with no concern for when I ate, get reading over 150, go get insulin. A nurse told me Medicare mandates the insulin with BG over 150. Daily, I had to refuse the insulin. Made me sign release document that I was refusing care. It’s a glaring gap in hospital responses to your medical needs outside the immediate issue as to why you’re there in first place

#47

4 days running at those levels destroys me. Maybe I am being too dramatic, like maybe I am really intolerant of the feeling of being 350, but I REALLY don’t like high BG feeling. I will do ANYTHING to get outta the hospital. Am I a spaz? I feel like I’m dying in the desert after days there.

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#48

I don’t get what the big deal is, the best place to be in entire whole if your going to have a bad hypo is when you are already in the hospital.

How is hypoglycemia treated in the hospital?

When symptoms occur, early treatment involves having the patient eat simple carbohydrate. In an NPO (nothing by mouth) patient, viable alternatives for treating early hypoglycemia include giving an intravenous (IV) bolus of 50% dextrose, or, if absent an IV, giving intramuscular glucagon.

Concerns about hypoglycemia are often exhibited in physician orders. Although endocrinologists have been warning against its use for decades, the regular or rapid-acting analog insulin sliding scale without basal insulin replacement remains a common method of attempting to control hyperglycemia in the hospital.[13]

(http://spectrum.diabetesjournals.org/content/18/1/39#ref-13)

#49

I had my own insulin and syringes when I was transferred from ER to hospital for observation. I ended up in a standoff with the nurse, refused to hand over my insulin. Another bad thing about hospital was reactive treatment, only wanted to give insulin after BG is high.

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#50

I can empathize with you Don1942. Any time I’ve been in the hospital they use a “sliding scale” for dispensing insulin. That “sliding scale” results in very small doses of insulin being administered. Hospital staff administers the insulin on a reactive basis. For example, they give you a meal and then do a blood stick sometimes hours after that meal, instead of giving you an insulin dose when you eat the meal. I was in the hospital for abdominal surgery. I fought with hospital staff to allow me to control the insulin when I was admitted. They gave in and let me control my insulin dosing. However, I had one incidence of slightly low BG and they immediately told me they were taking back control of the insulin. They told me they’d prefer to have patients in the 200 range. I thought that was a crazy approach but it seems to be the norm in hospitals.

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#51

I guess the ‘big deal’ is that if hypoglycemia occurs in the hospital, then the insurance company docks them $.

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#52

How did the standoff end? Were you victorious? Or, did they just wait until you fell asleep and take it away?

#53

I wonder what professional hospital staff would answer if you asked them, “What I hear from you is that you’re willing to deliberately permit my blood glucose to rise to excessive hyperglycemia. Are you also willing to accept the responsibility if, due in part to this deliberate excessive hyperglycemia, I acquire a hospital super-bug or my healing is compromised and leads to an infection?”

I realize this is a rhetorical question but it angers me that hospital professional staff are willing to compromise your health to ease their unreasonable fear of hypoglycemia.

They can’t have it both ways. Insulin is a double edge sword and they need to respect it and take appropriate action, like more frequent fingersticks. Or simply let the willing, capable and informed patient to take complete charge (and responsibility) of insulin dosing decisions

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#54

Terry4, I appreciate you comments. It’s ironic that you mentioned acquiring a hospital super bug as a result of having high BG. I don’t know if scientific studies would back me up but I believe that if my BG is higher than 200, I am more vulnerable to catching things. And BTW, in a subsequent hospital stay that I had, where the hospital (mis)managed my insulin, I did catch C-Diff. They released me even though I wasn’t feeling well and couldn’t eat. I went back to their ER the next day. Here’s an interesting side note - they wouldn’t re-admit me. They said I had to be admitted as a new patient. I found out why they did that…the feds keep track of the incidences of C-Diff and MRSA that patients catch while in a specific hospital, so the hospital didn’t want the record to show that I caught it in their hospital. The good news is that Medicare ended up linking my previous hospital stay with the one in which they treated me for C-Diff and denied their entire claim for the second hospital stay.

You hit on an important point, though. Keeping patients BG at higher levels will retard healing and increase risk of infection

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#55

There are lots of studies on this. Its widely accepted that diabetics have a higher incidence of death at the hospital, although the longer your there, the higher the risk. So, like, its really a significant problem associated with diabetics in the ICU.

But, I would say that it is also a huge, intentional violation of the Hippocratic Oath, particularly the cause is so directly lined to insurance companies dictating how medicine is practiced.

Heres a study that says a bunch of the population is hyperglycemic, even if they dont have diabetes.

“The exact prevalence of hospital hyperglycemia is not known but it varies based on study populations and definition utilized in previous reports. Observational studies have reported a prevalence of hyperglycemia ranging from 32% to 38% in community hospitals,[7],[9]),[10] 41% of critically ill patients with acute coronary syndromes,[11]44% of patients with heart failure,[11] and 80% of patients after cardiac surgery.[12] The occurrence of hyperglycemia is even more evident in critically ill patients where 31% of the population will have at least one blood glucose reading 11.1 mmol/l (200 mg/dl) and nearly 100% will have a blood glucose > 6.1 mmol/l (110 mg/dl) during intensive care unit (ICU).”

#56

As best I can remember, it was a tactical draw and a strategic victory. They didn’t get my insulin or syringes, but I did use their insulin. I determined the doses; lied and told them half my usual dose which was about right. The hospital’s syringes had big fat needles and damn did it hurt.

And the strategic victory – for anything in the future, the insulin (and glucose checks) will be worked out in advance. If it’s not my way, it’ll be the highway and I’ll a find a hospital and providers that will work with me.

#57

That’s actually a pretty good outcome. I have not, yet, ever been able to negotiate to even that level. But, maybe I’m being too polite.

#58

I am very polite but also determined and that comes across. Of course, I have no idea if this will work in the future, but so far so good.

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#59

I did just that on 2 operations this year. I managed my own Insulin within specific parameters, and was obligated to use their 4x daily fingersticks for ICR boluses at mealtimes. They forgot to mention though that I wasn’t supposed to bring my own glucometer. I did, ended up using almost 100 strips in 4 days to manage my bgs. My CGM was a taboo subject, sort of like talking about Voodoo in a Church. I stayed between 100 and 140 for +80% of my stay.

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#60

Yes and no. My insulin sensitivity is 54, so that 1 unit per 25 points would be way too much for me. Still, you would think that the fact that my CDE has done these calculations, approved by my endo, and that my cgm shows that it works, would carry weight … but it doesn’t sound like they have the common sense to realize it.