I am steaming mad. I received a letter from my health care provider/system it started off rather snarky. "...we understand that you use an insulin pump" The new policy is that if you are admitted you will not be able to access nor use your pump. Now I understand that if I were not all mentally there, but are they gonna insist that I can't have my meter too? I've been an inpatient a few times, always with my head on straight and clear. In my experience, I was lucky to get two bg tests a day, RN's insisting that Lantus and Humulog (or other fast-acting insulin) can share a syringe, sliding scale correction or carb dosing. I make full use of my pump. I have varying basal rates by time of day. My carb to insulin ration varies by time of day, as does my correction factor. And let's not forget the oh so important IOB. Before I moved here, after some scary inpatient episodes, I was put in charge of my D care. And everything worked out great! No rollercoaster numbers, I could micro-dose and keep within my chosen narrow range.
The reasoning seems to be that "pumps are complex machines" (again I am paraphrasing). Yeah, but the complex part is the brains of the device, enter the bg and the carbs and you're good to go. It is a lot less work, and more quality assurance with a pump. They said that RN's couldn't handle it. My Gawd! Children deal with their own pumping, and RN's work with a lot of sophisticated devices while caring for patients.
Anyway, my question to you all is do you think I should bring this up at my next appt? Supposedly the letter came from the Endo dept, and I have an apt with the head physician this time - so we can get to know one another. This issue came up when I had bunion surgery. The anesthesiologist was fine with my pump, and liked the CGM.
I'm sorry you're having this problem. I had a similar issue on mdi when I was in the hospital for the second time after first being in for dka at my diagnosis. First I was not fed all day after being in the er for many hours while I waited for a bed. I was then told when I got to the room that dinner was over and I wasn't going to be fed anything! I demanded that someone bring me a snack/sandwhich and then my nurse said that I wasn't going to be given any insulin for meals unless I was over 140! lol. I believe I already had all my insulin etc. with me. When I was admitted though the doctor said the hospital would manage the D. Well, I went a bit nutso on her and after a long argument they allowed me to manage my own bg testing and bolus for meals while they still did the basal insulin. Crazy stuff. I really was amazed at the ignorance of my nurse and the whole hospital with regard to Diabetes knowledge & treatment.
I hope you get this ironed out for yourself. Maybe it has something to do with liability issues due to possible errors by you or the pump in the hospital? I think you can fight this and win most likely.
Yes I received the same letter & I'm still fuming. I'm trying to make my thoughts logical before I contact them
I'm not sure what has brought this on. When I was admitted to the Kaiser hospital in Sunnyside in the summer of 2010 for tests after my heart decided to go into overdrive, the admitting doctor initially said I would need to disconnect my pump, I said NO, he went away & came back & said that after reviewing my records it was obvious that I could manage my own diabetes & they let me keep the pump. I disconnected for the heart catheterisation as X-Rays were involved & then reconnected & bolused for missed basal. They let me test & bolus for meals myself. I had more problems with the food, the gluten free stuff was tasteless & full of carbs! I got out as soon as I could.
Yes definately bring this up at your next appointment. From the letter I am not sure if this applies only to inpatients. What about out patient surgery.
A question to all the pumpers out there, do other hospitals have the same policy or is this just a Kaiser NW thing?
I was in Boston's Beth Israel hospital emergency room for chest pain and I was allowed to use my pump and manage myself. I haven't been deeper in the hospital than that since I started pumping.
Actually if your at BIDMC.. you get one of those lovely Patient Info sheets If your on a pump... they ask you a bunch of questions like I:C and basal rate (roughly.. not per hour).. and you basically decide if your with it enough at the time... to manage it yourself or not.... That was my last two trips to the ER there
I have similar issues and it drives me almost sane. Trust me, me as sane is like the worst thing ever. Anyway, my hospital will let me wear my pump, but they will not give me insulin and they act like the world has come to an an end when they see it. Oh my a pump, really a pump I have never seen one, how does that work, or it seems so complicated, or i want the basil every hour on the hour. Mr. Phillips what is your basil right now? well 1.78. Mr Phillips what is your basil this hour? Well 1.78. Mr Phillips what is your basil this hour? Well 1.92. did you get permission to change it, no it changes because it is pre-set. Really, how is that possible? Give me a break
Anyway so far I can keep my pump but they get testy if I have a meter. I suppose they know i cannot really use it without thier consent if I dont have a meter. One fool wanted to know if i used too much insulin where woudl I get more. Ahh home? Well you cant bring insulin into the hospital, really? Dude make up your mind. I cannot have your insulin, but I cannot being insulin in? I just do what I want and if it causes an issue i deal with it.
My endo is think the hospital has lost its mind. He said to do what comes naturally and if they ask tell them what I did, otherwise, just be quite about it
My favorite was the nurse who wanted to see my cool music player. She was fascinated that I keep track of insulin usage as well. LOL
I'll gladly sign a waiver if they are afraid of my pump doing something crazy. I even had a neighbor, an RN give me my meal dose today. She thought it was a lot easier, and obviously more accurate than calculating it in her head and she sees the wisdom of getting rid of the sliding scale as the only method. I am even gonna suggest that I keep my pump, fill the cartridge with water if they get ugly about it and use the pump as my dose-determiner. That way I don't lose the accuracy and I still have access to the IOB info. It's a repeat of the attitude that we can't, don't and/or won't do well for ourselves.
As long as a patient has the cognitive ability, dexterity, and interest in controlling BGs, let them do it. A nurse can do a daily interview and transcribe all the insulin data. When I read things like no insulin before meals if under 140, I think hypo-phobic and under-informed hospital staff.
When we as PWDs are in the hospital, we needs the best metabolism possible for healing and survival! Not some 140-250, hypo-safe, maladjusted blood glucose..
If I'm out of it, can't think clearly, or uninterested, then the hospital needs to take over and I must accept whatever ancient standards they employ.
I see one of these arguments in my future. It's just a matter of time. If my head's screwed on straight and my fingers work, don't try to take my pump away from me!
"permission to change your basal?" Excuuuuse me. I tweak it all the time - on my own. I'm the one in charge (as are all of us here on this forum, I'm sure. That's the beauty of the pump - you can make tiny changes, watch the results and act accordingly.
In my insurance docs it says that I can choose to monitor my diabetes or I can opt for the staff to do it if I am admitted. I’m with kaiser so I’m guessing that this is a hospital and or insurance issue that I’m sure you can work with. Sign a waiver or choose another hospital. Or he’ll a new insurer. Most doctors will say that insulin pumps are the gold standard in diabetes care. It seems odd to want to switch off. Esp when there would be a difficult time managing the change in dosages etc. dealing with that at a time that you are dealing whatever brought u there makes no sense to me.
While this letter is all and dandy, my understanding is that it can all be overridden with appropriate orders. Dr. B suggests that you have a letter written by either your diabetologist or the admitting physician establishing the "orders." If you cannot get them to write it, write it yourself. He provides a template in his book in Appendix B. Send a copy to the hospital administrator. It essentially plays on the fear of litigation pointing out that high blood sugars have been proven to lead to poor outcomes and that you expect your blood sugar to be controlled at least as well as you do yourself at home (after all they are "professionals" at a hospital). And then list your standard of care, insulin pump, cgms, testing 10 times a day. Whatever. If they can provide improved standards of care, great, otherwise they should not endanger your health and simply continue your care by allowing you to do what you have always done.
That Kaiser would manage to the least common denominator is not surprise. They probably had one incident with a pump and then decided that pumps are bad all the time.
ps. adding a cc to your personal lawyer always adds a nice touch.
Ugh, how sinister. I hate stuff like this. I agree with BSC that it's time to jump some heads. I've had a couple of outpatient surgeries and the staff has always been very supportive about leaving me hooked up to my pump. I can't see any reason a nurse shouldn't be able to manage a pump, even if they need to do something with it.
Seriously? This is the most ridiculous thing I have ever heard. I have two responses to this from two different perspectives. Firstly, as a patient, if I had a choice I would go somewhere else I would or heads at the top would roll. I would never chance the control I get with my pump to someone else that probably isn't even an endo prescribing my insulin dosing by MDI.
Secondly, as a nurse, I see everyday the lack of experience, training and knowledge surrounding diabetes care in the hospital. It is frightening! I am a pediatric nurse, so when kids come in with pumps everyone freaks out because they don't know what to do or are intimidated by the technology. In my area, I believe the reason for this is that diabetes care and education has been taken away from the bedside and is done in an outpatient setting. We get these kids in and discharged to the outpatient diabetes center as soon as medically stable whether the parents know anything or not about diabetes. That process in turn eliminates the need for the bedside nurse to be competent in diabetes care and education. And the cycle continues until no one, like in my unit, knows how to manage a pump or provide diabetes education.
In my opinion, it is part of the larger process of "dumbing down" nurses. Just like bar code scanning for medications, it takes away the need for thought process of the nurse and relies on the accuracy of a computer program and it becomes a thoughtless task. I know it's touted as a safety measure to ensure right patient etc... but there are many processes like that in hospital systems that eliminate thought processes for the sake of patient safety. Maybe if someone would have to think then the safety issue wouldn't be an issue. Sorry for ranting. This is an extremely frustrating issue for me as a patient and a nurse and I tend to get long winded about it.
I've been looking around the internet this morning on this issue. It appears that this issue has been discussed and studied over the last several years. This article is from a nursing journal and I view it as a background document for the medical profession and hospital administrators in the process of developing policy for inpatient insulin pump use. It raises most of the the pertinent issues.
I have been in many of the Hospitals in the Dallas, Tx area and have never had a problem using my pump except for post opp recovery, and time spent in ICU. After my liver Transplant they let me restart my pump after 4 days, I also used my BG meter, they also checked every 4 hours and supplied me with carb info for each meal.They did bring in a outside CDE/PE to go over my pump settings, my transplant teem had no idea how to transition me back to my pump.
If your only going to be incapacitated for a few hours it makes no sense to rock the boat by taking you off your pump and then having you transition back. On my last hospital stay they set me up with a Novolog drip during my stay in ICU and I just inserted a infusion set 4 days after surgery and they removed the insulin drip. I was not eating in ICU so they did not have to bolus insulin for food....They where quite happy with Blood sugars in the 200 range and I was happy to be alive.
During major surgery and post op, it's likely that your pump settings are worthless. My post-op novolog drip was 350u a day, my pre-surgery TDD was about 42u.
