This is my worst nightmare! I actually have my basal rates, carb ratios and extra basal Lantus on my emergency info on my phone, in case I’m hit by a truck or bus.
I have only been to hospital for orthopaedic issues and accidents since childhood, so have always been able to manage things myself, armed with guidelines I found online about self management of Diabetes in hospital. I’ve never had any arguements, but I live in Australia. I’ve gone private for most things, with the exception of a badly broken finger which needed surgery (smallish regional town with no private hospital - I escaped smartly back to my home city for the surgery!).
I am a doctor myself, which unfortunately does change people’s attitude. It shouldn’t, but it really does. When I say something assertively and with authority about diabetes, they listen. I wish the same could be said for all well controlled, well informed PWD.
The only time I was hospitalized, for pre-term labor, a nurse came into my room in the middle of the night with a 5ml syringe FULL of insulin. I was so out of it, but knew that wasn’t right. After challenging her multiple times she finally left and returned a few minutes later with the charge nurse apologizing that she misread the order for 5u!!! She would have killed me! I appreciate all the shared stories here. Great advice on how to manage my diabetes on the pump if ever hospitalized again.
That’s horrifying.
I had to have a heart catheter last year. Before I went back, I checked my blood sugar, since I’d skipped breakfast. As they rolled me into the ER and started administering drugs, I set my pump to a temp basal that let my blood sugar run higher. But I made it a point to go back to the ER with my pump in my hand, still running, the whole time.
Thankfully, no one complained.
Wow! Although I’m not on insulin yet, I want to get my endo to write an official letter stating I am able to manage myself if hospitalized. Also stating the exact macronutrient levels to be in my meals.
On the other side, I’ve been an ICU nurse for about 40 years.
- I have no say in your insulin management. The physician writes the orders and if I vary them I am considered to be practicing medicine without a license and will lose my nursing license. Don’t shoot the messenger. The physicians write the orders. Ask to talk with the physician during the day, not at midnight. I work nights.
- I have had patients with physician orders to let them self manage. All I do then is ask them to keep me informed of their insulin. I still have to do the blood glucose checks because it goes into the computer medical record via our machine.
- Food? Terrible and usually totally inappropriate. Hospitals use catering services these days. Mine recently informed us that every one would get the same meal. Period. Huh?! So the diabetic, renal, cardiac, kosher, vegetarian, carnivor patients all get the same tray. Crazy, but nursing has no power over it. The patient can call and request specific changes, but I don’t guarantee that they can be done. There is also no nutritional data included. Good luck figuring out carbs or protein or anything else.
- What diabetic patients do we see most often? The ones who actually can’t manage insulin. Usually older type 2’s who are managed temporarily with insulin due to severe illness. Occasionally we get type 2’s who regularly take insulin, but they just do what their doctor tells them. Strangely, some rarely even check their own glucose levels.
- The type 1’s are often the younger adults who are rebelling, don’t want to manage their diabetes, (maybe it will go away?), and are on insulin drips for glucose levels like 500-700+. Then ther are the ones who practically live here. I know of 3. They binge on juice and ice cream and anything else available and then refuse to eat for a day or more until they binge again. Glucose levels all over the place just in one shift. They are also on dialysis with parts of their legs missing.
Conclusion. Talk with your physician, preferably before you are hospitalized. Have a copy of how you manage your insulin for unexpected admissions. Best if your endo writes an official note stating you know what you are doing and should be allowed to continue self management. Doctors like to see what they are agreeing to, especially if they don’t know the patient.
Having stayed in a hospital several times during my 50+ years od Type 1, I can only tell you that you must stand your ground and let them know you know how to treat yourself. The most problem I had was at Mayo but they did come around. I had a couple of out patient type surgeries with full anesthetic and had my pump and CGM running and everybody in the operating room loved the CGM as that would give them a true curve of what my BG was doing every 5 minutes and not just a finger prick once a while.
Explanation of how the pump and CGM worked only made it better for all parties involved but due to my knowledge and pre-setting of basal rates on the pump nobody needed to get involved in applying insulin and I would get something to eat in the recovery room to everybody’s surprise.
Great to have the perspective from the other side of the IV drip, @Kailee56, thanks–very illuminating!
I have been in several major hospitals over the last few decades and for some reason have never had this problem. Last year I was in hospital for five days with pneumonia. I told the admitting doctor that I was on a pump and would control my own BG levels. I was told that would be fine and apart from them checking my levels twice a day that was it.
Just as an aside, 55 years ago in England, a student nurse came in and told me she was going to give me my regular evening dose of 30 units of insulin. She stood at the end of my bed and proceeded to fill a large glass syringe with what seemed to be a huge amount. When I asked if I could check the amount before it was injected she handed me the syringe. She was just about to inject me with with three hundred units! The very nice nurse apologized and corrected the amount. She later became my first wife.
Just found this article and thought it had helpful info. Doesn’t deal with insulin, but does give strategies for getting appropriate food choices
The one time I was in the hospital for surgery the nurse came in and checked my blood sugar and told me it was high. She looked at a chart and said I am suppose to give you 7 units to correct the problem. I told her if she did that that my blood sugar would be 0. I was then told I could manage my own diabetes. Scarry
At least they listened to you and made the right choice to let you make the insulin dosing decisions. Somethng tells me that this nurse had an uneasy feeling with this correction dose and was smart enough to check-in with you before following the order.