Insulin at the hospital

#101

I don’t know. I have always been somewhat more sensitive to insulin than average, I think. My carb ratio varies from 9 to 10, depending on the time of day. And my usual total daily basal dose is about 18.5 units. Frankly, I have been diabetic for over 30 years, and I am very aware of what works for me, and full of theories as to why some things work better than others; but I haven’t been connected to the diabetic community enough (until the last year, or so) to know what is considered “normal” or “average.”

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#102

@Yve65 - We all are inclined to believe there is a “normal” or “average” number for all things diabetic (Insulin:Carb ratios, Total Basal dosages, etc etc). The truth is even for identical T1D twins (same DNA, same size/weight/fitness levels), these numbers can and will vary dramatically.

The only number that all T1D’s should be mindful of is their target A1C. The closer to non-diabetic, the lower the risk of long term related health problems.

Does a diabetes advocasy organization without pharma funding or ties to the medical establishment exist?
#103

I have the answer to this mistreatment of diabetics in the hospital .

"Members of MindFreedom International use mutual support to protect one another from unwanted coerced psychiatric procedures. Current MindFreedom members may register for the MindFreedom Shield for free. Then if a member with a Shield is threatened with coerced psychiatry, that member can instantly activate a public alert system. " https://mindfreedom.org/shield/

All we have to do is copy that idea and make one for us.

If any one of us is in the hospital in a bad situation, that member can instantly activate a public alert system. An alert goes up on a website, maybe even this one, an alert goes out and then all of us back up the person in the hospital making calls ect.

The mind freedom shield works, the high blood sugar in the hospital shield would work too.

This method has already been proven effective.

#104

good thinking. I’m not sure I fully understand how it works. Will need to read. Message me directly, if you have useful information.

#105

“Standard of Care” is a legal concept not a medical concept. It represents the absolute minimum that can be done to avoid liability. For profit healthcare is very poor when measuring outcomes and on cost. I am 2 weeks out of the hospital with VTAC. Cardologist is not capable or equipped to manage co-Morbidity.

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#106

Thanks for that clarification. Dies anybody know if there is a standard of care for diabetes? Certainly there is for diagnosis. After that, it seems like they just roll the dice any which way. There’s no consistent treatment or protocol. Why is it like that?

Do you have an endo? Do They communicate? Or, is that an unrealistic expectation? Seems like you are someone who needs a good relationship with your endo. You might need an endo who will show up at the hospital. Did they talk when you were hospitalized? How are you feeling?

#107

I have moved several times since I started working with my endo 26 years ago. He is now located about an hour and a half from where I live now and, accordingly, would be unavailable during an emergency.

I wonder if my local hospital would abide by his telephonic instructions?

#108

Its possible. What I dont know, is how would he even know you are there? Like, they must not call him. The EMR wont notify. I dont know how they all communicate.

#109

I spent a lot of January & February this year in the hospital to get a total of 4 surgeries (ouch!). My BG usually ran about 350-400 there. I asked for more insulin but was told that they had a protocol saying how much I could get. My usual correction bolus is 1 unit to lower 16 points. Theirs was 1:100. And they wouldn’t let me use my pump without a doc’s order. And finally, they only use Humalog. For me, it requires 50% more Humalog than Novlog. Since I was only in 1-3,days each time, I seldom saw any doc, and none I saw was one I had ever heard of.

After the whole thing was over, I asked my endo about it and he told me that this hospital’s insulin protocol was well known to be ridiculous. I am to tell any admitting physician from now on to write an order saying that I get to tell the nurse what insulin dosage I am to get.

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#110

My wife knows when I am in the hospital and she could call my endo and ask him to instruct the hospital how to treat my diabetes. I am not scheduled for a check-up for another three months, but I will talk to him about it then.

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#111

Submitted to the paper…

Dear Readers,

In regards to recent legislative efforts to confront “price fixing” by insulin manufactures, I hope to voice a desperate plea. While I am hopeful that efforts to confront obstacles to care at the highest levels of the system are successful, I worry about how the tentacles of the current paradigm feel their way down into the fundamental practice of medicine. As a patient, I ask for medical advocacy from within the hospital system. I ask because I am desperate. I ask, because healthcare workers are, fundamentally, not advocates for insurance companies. Insurance companies don’t need any more advocates. Patients do.

Returning to centuries old standards of medical practice to “do no harm,” can help decrease litigation. Patient communities are mobilizing. There may be a firestorm of litigation brewing inside a system that is likely to ignite in the next five years. If I am honest, 25 years as a patient has sparked a strong desire to see the system burn to the ground. I have a deep emotional desire to dance around it, like a madwoman, laughing, while it incinerates. I know that I am not alone.

How do providers protect themselves from the oncoming firestorm? Do the right thing and do your best. Nurses and Doctors are capable people. Do not take advantage of those weaker than you for personal gain. It is not easy to have words with the Devil, but sometimes it is necessary. Take lessons from lower levels of healthcare. Paradigms for patient advocacy abound, and are stronger, at the street medic and EMT levels of healthcare. Lessons might be learned from those who have the comfort of working inside less authoritarian environments. Read some Solzhenitsyn. Reflect on what is like to be held down by a massive, all-encompassing system that dictates every facet of your life. Doctors and nurses face the same professional obstacles that patients face personally. We ought not to be working in opposition. That serves no one in the long term.

I strongly urge the hospital system to begin understanding how to administer insulin in order to provide some basic standard of care. Patients do it every day. We do not expect perfection. However, we do expect a basic level of care during hospitalization. The current practice of medicine, on this front, is patronizing, negligent, damaging, and self serving. It is below you. We know that you are better than this. For patient perspective, or to discuss this further, I invite you to our patient community discussions (Insulin at the hospital).

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#112

I suspect you mean that healthcare workers are advocates for insurance companies.

#113

ahhhh, I see how you read that. Woops! My bad. Didn’t read. Just wrote and submitted in a moment of impulse. hehehehe

image

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#114

My neighbor is a 21 year old boy, who was diagnosed with type 1 very recently. He felt weak, thirsty, hungry and looked painfully thin. Our other neighbor is a nurse and he asked her what he might have. She called me and asked if I had an extra meter and test strips. His BGL was 350ish.

We told his parents he had to go to the ER on a Sunday. He was released Monday with 1 bottle of R, a script for humalog & lantus. And a sliding scale to dose with. He was checking and correcting, but wasn’t told to count carbs and take insulin for food. He didn’t see an endocrinologist, only a dietician. I was livid. I did his new diabetic training. Taught carb counting. Guessed on starting carb ratios. Told him to check pre and post meal and adjust as he went. I also bought him “Think Like a Pancreas” hoping it would provide more in-depth insight.

He went back to college. He finally has his first endocrinologist appointment in early May after finals. He is doing fairly well. But only because he lives in our neighborhood with second and third mamas looking out for him.

10 Likes
#115

Just wow. Thank you so much for stepping in and helping him get some solid footing! It is so unfortunate today that endos are so hard to get in with — when you need them, let alone in a time of crisis. Thank you and your neighbor friend to paying it forward by being second and third mamas! Kudos to you both!

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#116

OMG, @laceyma, you are godsent. Thank goodness for benevolent neighbors. I have to believe that good karma comes around.

It troubles me deeply when healthcare fails to do what a few good volunteers can do for free.

#117

@laceyma - Well done :+1:t3: :+1:t3: :+1:t3:

It’s stories like this, and people like you who give me hope for humanity.

Unlike the indifference many would show, you’ve stepped up and are doing infinitely more to help this young man than those at the hospital.

#118

Personally, I think I prefer hospitals in Seoul, Korea. When I was admitted to the hospital, as per hospital custom, I brought all of my meds with me, including insulin and pump. The nurses wanted to know what meds I was taking, but assumed I knew what I was doing. Being admitted to US hospital, the nurse kept asking question after question about how my pump did calculations. When I could not answer one question, she suggested that they might ask me to remove the pump. I mentioned leaving AMA. She eventually left me alone.

As far as being admitted for outpatient surgery, the doc had no issue with pump but did want to do an IV to keep glucose level around 160 during procedure to be sure of no low during procedure.

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#119

What is AMA?

#120

In this case it would most likely be Against Medical Advice.