I recently had day surgery (knee), while using my loop app, CGM and pump. The anaesthetist was thrilled to look after my phone in theatre, because she could see the benefits to having my glucose level at hand. I unlocked it so the screen wouldn’t sleep (face recognition doesn’t work with a breathing tube…), but without face recognition, she couldn’t bolus me:blush:
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I actually requested steroids to be given to prevent nausea, as I get post op nausea ++++, and steroids really help. My loop sorted it all out with no drama.
Phones can be taken into theatre, worst case they could be put in a sterile bag. But the anaesthetist is not a sterile being either, and they are allowed to stay😊.
I need another arthroscopy now, as I damaged my knee again, and we are back to square one😑.
I recently had to go to the emergency room because we thought I could have appendicitis ( turned out it wasn’t anything serious) but the Dr. and nursing staff did know about CGM’s and asked questions like what was my BG that morning and didn’t try to take over any of my diabetes care. That being said I didn’t eat anything all day since if I did need surgery I would have needed to have not eaten.
My brothers girlfriend is in nursing school and she used CGM’s as her class paper on emerging medical technology with a little help from me on the different kinds, how they work, etc. I guess it just depends on where you end up going for treatment.
Once I was in the hospital from late Friday until early Monday, and since they kept taking me away for lab and radiology tests every time a meal arrived, I would always return to find that the meal had been taken away. The result was that I ate nothing from the start of my stay until the end. Fortunately I was allowed in that particular hospital to control my own insulin dosing, so I could avoid major problems by keeping the background dose low. But if I had already taken a pre-meal bolus, or if this had happened to a less experienced patient, tragedy could have ensued, and yet the hospital had no idea of the risks it was taking.
I think some of the lack of knowledge is also where you are in the country. Every surgery I have had has been here in San Diego county. And the few hospitals I have had surgeries in, everyone has some knowledge of CGM’s and a little less on pumps.
I do think the statement of a person using a pump must know what they are doing, is very false. Just because you have a pump, doesn’t mean you are on top of everything. Where I was when I first started on a pump and where I am now, 2 different books of knowledge.
I do feel ok about a hospital stay. But the few times I have stayed overnight, my endo has always been there with written orders for me to handle my diabetes and if there were questions, I was he person to ask.
Definitely, Dave…
On Memorial Day I was hospitalized following a stomach virus which brought on 24 hours of vomiting and diarrhea resulting in severe dehydration causing my BG to rise “over 6Oo” according to my meter. After testing, the emergency room doc advised that the severe dehydration had caused my BG to rise over 1000 and the combination brought on keyto acidosis, renal failure, and a heart attack.
Several days later while recovering, my BGs were still highly elevated and after being tested I was advised that they were at 430. When I requested a shot of insulin, the night nurse asked me why and though I told her I was diabetic, she ignored my request. Several hours later, I was tested again which revealed a reading of 438 and again my request for insulin was ignored by the night nurse. I request to see the head nurse who reluctantly agreed to inject 10 units until the endocrinologist could check me in the morning.
I wonder what on earth these idiots in the hospital think we do at home? Stand there vacantly staring, having absolutely no idea what to do when we have hyperglycemia until we can get the endocrinologist on the line?
That pretty much sums up the inability of hospital staff to give diabetic patients confidence in their hospital stays. My own experience sure bears that out.
I have a letter that I keep with my diabetic supplies or in my purse (or bike bag, pocket, etc.) that has instruction for Emergency room personnel. It says the following:
TO: Emergency Room Staff
YOUR NAME uses YOUR PUMP insulin pump, a DESCRIPTION OF YOUR PUMP. Please check her person or purse for the diabetes management kit. This pump delivers Novolog insulin. It matches YOUR NAME’S insulin needs as determined by history, blood glucose levels, food intake and expected exercise. Normally YOUR NAME checks her blood glucose levels with the glucose meter built into the pump display and adjusts insulin to maintain as near normal blood glucose levels as possible.
Insulin is given in two ways with an insulin pump.
Basal rate : a continuous insulin infusion; the amount of insulin Sharon requires to maintain a normal metabolic state when not eating.
Bolus : the insulin infused with each food intake. Sharon has been taught to adjust the bolus depending on blood glucose levels, food intake, and expected exercise.
INSTRUCTIONS:
- Leave the pump in place. Continue the basal rate even if is unable to eat .
- Allow YOUR NAME to test her own blood glucose levels with a glucose meter and adjust the bolus using the insulin pump. The bolus will be adjusted as follows:
Basal Rates Bolus
ADD PUMP BASAL RATES HERE
Insulin/ carb ratio
ADD RATIOS HERE
Insulin Duration: ADD NUMBER hr.
Correction = ADD CORRECTION NUMBER
-
If YOUR NAME is ketotic, the pump may not be working properly or may be blocked. Have YOUR NAME change the POD OR INFUSION SET with one that she has in reserve. YOUR NAME should check blood glucose levels every 2 hours afterward and give bolus doses as needed according to the chart above.
-
As noted previously, continue the basal rate if YOUR NAME is unable to eat. She should check blood glucose levels every 4 hours and adjust her bolus as needed.
WARNINGS:
Do not remove or discontinue the use of the pump without giving insulin by another means. Otherwise, YOUR NAME will have no insulin and will develop ketoacidosis. If the pump is discontinued, YOUR NAME will immediately need Lantus (long term) and Novolog (short term) insulin.
Blood glucose measurements must be current. For safety, make adjustments from YOUR NAME’S readings rather than waiting for blood glucose results from the Lab. YOUR NAME has been trained to do this and routinely tests her blood six – eight times a day.
The exceptions to this rule are if YOUR NAME’S ability to perform intelligently is compromised or if you have concern about the accuracy of the pump and glucose meter.
If YOUR NAME has an infection or is under stress, blood glucose levels may be elevated. Continuing the basal dose and covering high blood glucose levels with boluses is a reasonably safe way of protecting YOUR NAME’S health.
Information:
Patient’s Name: YOUR NAME
DOB: YOUR DATE OF BIRTH
If you have questions, please consult :
YOUR ENDO’S NAME AND ADDRESS
Phone: YOUR ENDO’S PHONE NUMBER
This insulin pump:
Make: PUMP MANUFACTURER
Customer Service Number:YOUR PUMP’S CS NUMBER
I don’t know if this will always work, but at least it is worth a try! Even if an Endo does not have privileges in a hospital, the doctors there can always call him/her AS A CONSULT. I just started with a CGM, so I suppose I need to adjust this letter to add that fact, too. With this paper, at least the staff has been told my wishes and what I legally want done if I am unable to communicate with them.
Again, I think it’s more of an issue with injections than with a pump. Part of this goes back to the fact of insulin being a unique medication in that patients have to administer injections of this potentially dangerous stuff themselves, based on their own dosage decisions—something that goes seriously against the grain of the medical profession in general. It’s even more acute in the context of a hospital, where the hierarchical mindset is deeply ingrained. Under all other circumstances it’s the doctor who specifies the times and doses of medications; it’s the nurse who administers the shots if shots there be, and under no conditions do patients go around making up their own doses and injecting themselves willy-nilly all by themselves. Anarchy! Somehow a pump gets around this by being attached and programmed, presumably with much physician oversight, and it’s just button pushing. As opposed to the the patient actually taking a vial and syringe (or injection pen) into their own hands (!!!) and pulling up whatever dose they have in their crazy little heads and shooting it into themselves. Even if they know we do this routinely everyday throughout our lives, on some deeper level I think It’s hard for them to get past the feeling that it’s… just wrong!
At an English hospital where I was patient the Nurses Union threatened to complain to their employer if I was allowed to administer my own injections.
As mentioned in my post above, the nurse begrudgingly injected 10 units of insulin. To add insult to injury, when I got my Hospital bill, one of the charges not covered by my insurance was $15 for insulin not prescribed by a physician.
Correction factor and insulin/carb ratio are 2 things that I tell anesthesologists or anyone else who I depend on for help when I’m “under” or foggy from painkillers. When recovering from a surgery a number of years ago I had to be on morphine for 3-4 days. It’s nice to have the staff have some sort of clue about insulin needs, should they have to administer it if I’m too foggy to do it myself safely. One time, years before I got my first pump, and recovering from surgery, I got yelled at pretty good for injecting and forgetting and doing it a second time. I’ll never forget that! don’t try to “do it yourself” if you are too far under the influence of drugs.
I also show the anesthesiologists how to suspend my pump should the need arise. It’s not likely, but it doesn’t hurt to let them know what buttons to push.