Insulin at the hospital

#61

@Yve65, what do you think makes you different than the typical or average? Is it something obvious? Like, are you small framed? Or, is it something more subtle and metabolic?

#62

I think everyone is different. I’m obese, but my correction ratio is still 1:33, and it’s more than doubled from when I was an equally obese teenager and my correction ratio was 1:15. My ICR is 1:6.5 or 1:7.5 throughout the day, which seems much higher than the correction ratio; it’s just another of those inexplicable diabetes mysteries.

One of the more realistic diabetes on TV moments I saw recently was on “the good doctor” when a diabetic patient is saying my blood sugar is over 600, I need more insulin, and the doctor says “I gave you 10 units; that’s standard practice; you need to wait.” And the patient tells him that 10 units won’t do anything for him, and he needs substantially more insulin and starts to argue. I thought, "yeah, even with a correction of 1:33, I would want substantially more than 10 units if I were over 600 because of ketones. I would argue too. I guess standard practice is to ignore the patient to protect yourself.

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#63

In Dr. Bernstein’s Diabetes Solution I recalled reading about his personal experience with hospitals and dosing. He has drafted a letter for patients to use when going in for elective (planned) surgery.

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#64

There is always good old Youtube/Facebook and video recording intimidation. Its not nice at all but record the interactions with staff on your phone for your lawyer and Youtube revenge. Live stream it.

Its total bull, its sad to have an adversarial relationship with the hospital though, that just sucks. It should never be like that.

This just makes no sense to me with the invention of continuous glucose monitors I just don’t get why they would want people running high.

I am sure a big bulky hospital version of a CGM could be made very accurate even multiple sensors for redundancy.

#65

tl:dr (meaning I’ve read a few replies but not all)

These stories are just scary. I’ve had two surgeries and another procedure which required being put under over the last year, and they were really cognizant of where my blood sugars were. Because they were surgeries, I wasn’t allowed to eat and was released the same day, so I know that’s different than coming in via the ER due to some sort of trauma and having to stay overnight.

The first thing I’d do, if I were able, is to make sure my endocrinologist knew I was hospitalized and ask him to share my info with the team treating me. I can’t imagine being in the hospital for something unexpected, dealing with that stress, and THEN having to worry about high blood sugar too. Yikes.

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#66

So, I have a question about the possible misunderstandings about high blood glucose in the hospital.

In the past, I’ve had negative experience in hospital with nurses and/or doctors tell me that running high for a short period of time does not increase the chances for infection. It’s not something that I’ve researched, but this seems totally counter-intuitive to me. After all, infections can and usually do enter the blood stream, and it would seem that if your blood glucose is high (thus creating “sticky” blood"), it stands to reason that your body would have more trouble fighting infectious organisms. Is this logical, or am I thinking too highly of my own power of reason?

#67

The correlation between blood sugar and infection has always confused me. I guess everyone is different, even in this. For me, I get sick just as often with an hba1c of 6 as I did when it was 14, which is not very often at all, especially considering I work with little germ monsters.

When my hba1c was around 11, my brother came to stay with me for a few days. I lived in a studio apartment so he slept 4 feet away from me on the floor. He woke up covered in chicken pox, and I had never had chicken pox. I still have never had chicken pox despite clearly being exposed with high blood sugars. Another one of those mysteries I never figured out, but I haven’t developed a stronger immune system since getting better control, so it’s not an absolute.

#68

This is kind of a perennial topic, but the last time it came around I seemed to hear a lot more from people who said if you talk to staff ahead of your stay (assuming it’s a planned surgery or whatever) and go in with a note from your endo, you’ll be allowed to manage on your own. My own experience, not having known to do that, was much more of a guns-drawn Mexican standoff, of the kind @William7 described (in my case I won, but it didn’t come easy). But here’s the other big difference I’ve noted: it seems to be much more of a problem for MDI than for people using a pump. Which to me is kinda revealing.

There are a lot of factors at play—hospital policy, insurance strictures, prohibitions of patients administering their own medications while in hospital care. All of which makes a deal of sense, except in the case of insulin. And to repeat myself from other threads, this just is something that goes against the deep training drs and nurses absorb from the start. The whole concept of a potentially dangerous medication that you just hand over to the patient along with some rules about carbs ‘n’ ratios, and then say “Have at it, try not to kill yourself and we’ll check in again in a few months” goes deeply against the grain. Even more so in hospitals, which are densely rule-governed institutions. So no, as a rule, they’re not going to let patients bring in their own drugs, far less figure out their own dosages meal-by-meal and hour-by-hour, that’s just crazy talk. Except it’s the only way to do it, for us, and like it or not (mostly not) that’s what we’ve been doing all along outside the hospital because there just isn’t any other way to do it. But in the hospital, they sure aren’t going to tolerate that, let alone try to figure out your doses by calculating how many carbs are on that plate of hospital food and factor in your I:C and all the rest—they’ve got other patients to see, not to mention doctors have to approve any administration of meds; your nurse can’t just do that on his own. So at best they’re going to hit you with some kind of one-size-fits-all sliding scale, let you run high because that’s not nearly so scary (for them), and get on to the next room on the ward.

I think the reason a pump tends to be an exception to this treatment is also part of the pattern. Because, well, it’s a machine, isn’t it? It’s got a computer or something, it’s not just the patient thinking up whatever crazy number comes into their tiny little heads and doing an injection to themselves—not just a pill, an injection f’r godsake! Plus you’re attached to it—it’s a prosthetic device—so that makes a difference too, psychologically if nothing else.

Anyway, I’ve posted on this bias a lot of times, but it’s interesting how it can pop up in different ways. I think it has a lot to do with why doctors LOVE the 670G for instance: locks up the controls so patients can’t get their sweaty little fingers on 'em, those aren’t for you dearie—but that’s a whole 'nother topic.

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#69

Some of us go in through the emergency room. Perhaps we should have our Endos/PCPs prepare a letter to keep ready for use under emergency situations.

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#70

I’ve only gone to the emergency room a few times in my life (at least since diagnosis). Twice were diabetes related when I was a preteen. We couldn’t figure out why my bg’s were high and for both of those visits I don’t remember getting any insulin administered.
Recently I went to the emergency room because I was worried I might have had appendicitis. I was there most of the day and no one tested my BG or asked what the readings on my CGM were. My bg’s were stable BTW and I didn’t take any insulin but if I had needed it I would have dosed and I seriously doubt anyone would have noticed.
Nobody tried to take any of my belongings away so I had all of my supplies. I think it would have been different if I had needed surgery or I was unconscious but that wasn’t the case and they just let me take care of myself. They did however ask what my fasting BG was that morning and noted down what meds I take and dosages.

#71

I fail to understand this preoccupation with fasting BGs, especially in a T1, and on a pump. Can anyone explain that to me?

#72

@Willow4 - I too shake my head in amazement when healthcare pro’s talk about / request “fasting BG’s” from a T1D. Given CGM tech, fasting sugars are so “yesterday” for those of us using a pump.

Most of us are proficient at SugarSurfing, glancing and micro-dosing, whether or not we’ve ever read the book.

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#73

Here’s one National Institute of Heath source I quickly found on this topic. It mentions how things have changed over the years.

Until 2001, hyperglycemia (blood glucose concentrations up to 220 mg/dl) had been tolerated in critically ill patients not only because high blood glucose concentrations were believed to be a normal physiologic reaction in stressed patients and excess glucose is necessary to support the energy needs of glucose-dependent organs, but also because the true significance of short-term hyperglycemia was not known.

This publication asserts that increases in hyperglycemia increases morbidity and mortality in critically ill surgical patients.

Recent clinical data show that the use of intensive insulin therapy to maintain tight blood glucose concentrations between 80 and 110 mg/dl decreases morbidity and mortality in critically ill surgical patients. Intensive insulin therapy minimizes derangements in normal host defense mechanisms and modulates release of inflammatory mediators. The principal benefit of intensive insulin therapy is a decrease in infection-related complications and mortality.

I do think we, as people living with diabetes, live with varying quality of immune systems and some people, like yourself, enjoy a good immune defense even though you have diabetes and experience high blood sugar from time to time.

My personal experience with extended hyperglycemia is that it makes me susceptible to infections. When my A1c was over 8%, I developed an infection in a tooth after a root-canal procedure. The antibiotic used left me struggling with a month-long and stubborn c-difficile infection.

During that time with high A1c’s, I also experienced several respiratory infections including “walking pneumonia.”

The connection between hyperglycemia and infection is a strong one but normal human physiology variation will produce exceptions to this tendency. @BeckyZ, you are lucky to be blessed with a good immune system!

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#74

Likely also that pump users are better educated, more affluent, and less likely to take no for an answer.

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#75

Thanks for posting the research, @Terry4. I didn’t have time to find a good article.

Sugar in the blood feeds infection. I don’t think there’s any question about that. This is always going to be a concern after surgery or after a heart attack.

I am definitely prone to infection. Off the cuff experience suggests that after a couple days of highs, I am more likely to develop minor infections (infected hair follicles, yeast infections). I am pretty much guaranteed secondary infections when taking antibiotics. Hospitalizations of more than a day or two start to concern me. If I ever have a heart attack, I dont expect to recover.

#76

I understand your pragmatic realism but encourage you to hold more hope. The brain is a powerful driver of the body’s ability to heal itself. In fact, science has shown that even an invalid belief can influence positive outcomes. Consider the “placebo effect.” Don’t give up on yourself prematurely!

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#77

Just saying, I am educated, affluent, and determined to give my own insulin in the hospital. I do not use a pump.

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#78

LOL! I never thought of myself as affluent, and certainly not because I happen to pump. good point, Marilyn. :slight_smile:

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#79

Obviously the question of who “us” is is the crux. We in the DOC, and this site in particular, are a pretty self-selected bunch, but my understanding is that the vast majority of T1s are far less well informed and well managed, so expectations at the institutional level are going to be geared to what they see much more frequently.

Yes, there’s certainly no inherent link there (some of my best friends are on MDI :wink: ), but I think from the perspective of hospital staff they’re going to tend to assume that pump use implies a higher level of sophistication, not least because they themselves may have little to no knowledge of exactly how they work—it’s specialized area within a specialized area. Not saying the assumption is correct of course. I was on MDI when I ran into this particular hospital stay snafu, so I’m with you on that.

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#80

I didn’t mean to imply that nobody has a correlation between high blood sugar and infection, which is why I said everyone is different. I was just pointing out that once again, this disease is not always logical nor straightforward. Just like other people feel high blood sugars, but i can still climb to 300, and not feel a thing.

My personal issue is my body (especially my stomach) just randomly shutting down. For over a decade, the doctors blamed me and my high blood sugars for my constant throwing up. Now, they’re trying to connect it to what I ate (food poisoning, etc.). It happens no matter what I do, but people insist on finding correlation and logic in these things. It bugs me because in my case I normally get accused of making things up or lying about my patterns of behavior because they want to explain it and the easiest way is to question the source. My point is we all have our boulders to push. I am sorry you get infection easily.

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