Wow! That's enormous! My two surgeries, neither of which were "major" (umbilical hernia, excision of cyst...) I think didn't really require that much adjustment. I don't recall changing anything and coming out of surgery in the 90s although I have no idea what they did. I was out of it but looking to escape as soon as possible. The first one, I was pretty hungry but food tasted *horrible* which I figure had something to do w/ the anesthetic? My mom had made soup (tomatoes, maybe too much acid?) but I didn't make any adjustments, offered to show them how to use the pump which neither team wanted to bother with (I figure they probably did some sort of balance of IV glucose or insulin to adjust it...).
I know that trauma can jack up your BG but going to 350U sounds crazy! Then again so does ending up in the ICU, getting a new liver, etc. I'm glad you have the right stuff and are able to share that though. You never know when you'll run into something like that or what Brunetta's dealing with here!
Sorry for that miscue. You're right, the document is behind a login form. I just verified that you can still get to it if you do a Google search using the term: "inpatient insulin pump policy 2013."
When the google search findings are listed, pick this one:
Management of the Hospitalized Diabetes Patient with an Insulin ... The first insulin pump was introduced onto the market in 1978.1 It was very large. (about the size of ... insulin pump. Crit Care Nurs Clin N Am 25 (2013) 111–121.
I've verified that it can be viewed using these steps. It is a pdf file.
I've also read that some intensive care unit (ICU) protocols use a glucose/dextrose drip in addition to the insulin. It's like they have one foot on the gas and the other on the brakes! That could explain the astronomical boost from 42 to 350 units/day.
i had inpatient surgery last year. they use regular in an IV drip and tested my blood sugars nearly every 1/2 hour all day and night long, they kept waking me up so much to do it (i wasn't wearing my CGM) and I was on so much pain medication, I was grateful they were so thorough. When you're admitted into a hospital, you're under their care, one can't expect a regular RN to know how to manage an insulin pump. When I was there, they did put me in some special recovery unit where the nurses there knew a great deal about insulin, BG's, etc...and the on-staff endocrinologist did all the orders in terms of my insulin management. Frankly, I wouldn't want anyone touching my insulin pump if I was in the hospital nor would I want to have that responsibility if I was medicated and they have to know how to manage your blood sugars. If you're having surgery, they typically don't use a basal/bolus regime, you'll have to check. They drip regular insulin. I stayed on that drip until I was ready to go home and then just went back to levemir - novolog that morning I was released. You can just restart your pump when you're recovered and ready to go home.
Yeah. Ever since my father was hospitalized years ago and his insurance bill showed a Pregnancy Test (thank goodness it was negative!) I have tried to be in charge of me and my medical decisions.
I am so appreciate of everybody's input - keep it coming. I have a copy of the Bernstein letter (in his book) and the ADA Smart Pumping book with me to take to the appt. I am also gonna check with John Walsh at his website (Diabetes Mall). I am taking this seriously, but I am gonna have a great time in the debate!
In my opinion, you were lucky that they were so diligent in the bg testing. That isn't the case usually. Because my rates vary during the day (sensitivity and carb) as well as the IOB info, unless I was not conscious, I want my pump. I've fought to have it with me in the past, and in the end the MD's and RN's were impressed with the pumps simplicity - the hard work is already done by me in terms of personalizing, and the IOB what really got them excited (in a good way).
yes, they did that with me and I was so medicated and confused, it was kind of like a 'who's on first'...i kept asking what type of insulin they were 'dripping', the nurse would say, 'regular insulin'...i'm like I know but what type of insulin are you using, she again would say, 'regular' and told me it had glucose in it too, i couldn't understand this. However, I was grateful too that they had glucose in the drip because I crashed badly overnight. My BG's never went above 200 during my stay. And true, what's programmed in a pump pre and post OP might not even work - the body is basically traumatized from the surgery, not eating, medications, recovery, etc....how is some RN supposed to know how to reprogam a pump and enter all new basal rates?
I had situations where I knew I was going low, and they wouldn't come in with their meter. Fortunately I smuggled mine in. And due to congenital kidney issues (less than stellar kidney function) I will not go above 140 at all. It's worked - no dialysis for 45+ years!!! (I was dx'd with the lousy kidneys at 15 years old, dx'd with type 1 at age 30)
well, you didn't say if this was in or outpatient, what type of surgery you're having, what you're recovery will be. Also, many people are extremely nauseous after surgery, i threw up all night long (ugh) so that again is why they need to have their patients on a glucose/insulin drip. EVERYONE's rates vary throughout the day, i'ts called type 1 diabetes. They IV drip of regular insulin is different then other insulins. i never bolused while I was there, I didn't eat until the next day and I just ate (not sure how they worked that out). However, there would have been NO way I could have managed an insulin pump. My nurse told me the next day I kept trying to test my blood sugars myself with my meter, I couldn't even put the damn strip in the correct way and I have no memory of the surgery or even waking up or the night prior.
I'm not planning on any surgery. I just received a letter out of the blue stating that pumps were not going to be allowed for inpatients. My first thought was, why should I have less than optimal diabetes control while in hospital? And, although it wasn't specifically mentioned, are they also going to tell me I can't test? Even with CGM I test between 10-15x a day. And that is why my A1c IS 5.2-5.4 for years - and not because of a bunch of lows. My A1C is in the mid-range for people without D and that is my goal. If I am willing to do the work and pay the money for the technology, I have every right to have the good control I want.
In terms of future procedures I may need, whether or not I can manage my own D is gonna figure into my decisions. If I do have to go on MDI, it is going to me administering the doses. It seems to be acceptable to the hospital people that 4 bg tests a day is enough - I disagree. And I want to do the mini doses I can if need be.
I also got the letter completely out of the blue. My 1st thought, what a wonderful Christmas present! The letter is so black & white, this is what will happen no ifs or buts. It says the pump will be disconnected but no mention of what insulin regimen will replace it.
Is this just Kaiser NW or all other Kaiser regions?
I'm going to bring this up at my next Endo appointment at the end of Jan or early Feb but I shall contact them 1st.
well, i just gave you the reasons why...so if you ever have to have surgery you will understand. you don't do MDI when having surgery, i just also explained that as did another poster. they can't be responsible for insulin pumps, basal rates, adjustments working or not working while you're under anesthesia and under their care. I also just told you I couldn't even test my own blood sugars, how the heck was I supposed to give myself insulin shots. they put you on an INSULIN DRIP. Have you ever had a major surgery under anesthesia, ones not capable of doing much especially with heavy pain medications. i said the same thing too, 'i want to manage my own blood sugars' which could have been deadly for me if they allowed it. As I also said, they tested me all the time. They do this ALL day long, everyday. So, unless and until you have a bad experience don't get so upset about it. You can't go into cancer treatment and dictate to them how much chemo you're going to get, that's their job, you can refuse it of course...but, they have protocol. I mean, what if there's an unexpected complication and your site comes out, they have to turn the patient, do an emergency procedure (whatever) and a POD falls off...they put you or whomever on a drip for your safety as well as their own.
Yeah, I didn't know an insulin pump was considered contraband! I usually see an NP CDE and we get a long fine. I believe I have convinced her I know what I am doing. Anyway, because I had mentioned that I thought one of the lead Endo's and I have friends in common, she suggested my next apt be with him so we can dish about people we know in Southern CA. I know that I had to make a strong case for wearing my pump and CGM during out[patient bunion surgery, I did convince the anesthesiologist that it would work better than my not having them. He especially liked the fact that the CGM would alarm when my trend arrow started to go down.
Did you get the sense that the reason was because RN's weren't familiar with pumps? After I received the letter, I was going over to a neighbor's house. She is an RN. I told her about the letter and explained the benefits. I also said that they aren't all that complex once they are programmed. So since we were going to have lunch. I tested, and had her enter the bg and the carbs into the pump. Following my walking her through it, she took care of my meal bolus. She thought it a lot easier than several of the other devices and gadgets they deal with as RNs for inpatients. I don't remember the names of the gadgets.
I don't know if it is just Kaiser NW or not. I do know that Kaiser NW will not support CGM for adults, but will for children. And the Kaiser in San Diego will cover CGM.
there's been numerous examples posted on here regarding different needs for insulin during surgery. what you program in will, in my experience and others too, will not work during a major medical inpatient procedure. this is insulin we're talking about, too much can kill us and we're already under anesthesia and certainly can't tell someone 'hey...i'm going low', nor can they pop a glucose tab into our taped and closed up mouths.
Yes, I have had major inpatient surgery - breast tumors removed. I was under their care for my D until I came out of the recovery area. Then I was allowed to get back on my pump, do my own testing as often as I wanted (I had my meter brought to me) and was back in range quite quickly. I totally understand if someone is too ill to handle it, but to make that blanket statement about all patients is in my opinion, inappropriate.
And as far as not wanting to be responsible for basal rate adjustment etc. Allowing a capable patient to handle it and to test as often as they need to, the patient will be able to appropriately make correction boluses knowing what insulin is on board.
All I am stating here is that if I am capable, I want the opportunity to manage my own D. I am doing a very good job of it, I know my body, and I know what to do. I don't want to have to wait until hospital staff do a bg test, then wait for them to either get the glucose or wait until they get MD orders to temporarily up the IV insulin Drip. And yes, I admit, I resent the assumption on the part of some medical people that [people with D can't do it themselves and don't ever take care of themselves. Again, I am upset because of the blanket no pumps allowed policy.
how are the supposed to know before hand if someone is going to be able to manage their own pumps, blood sugars, insulin shots after a major inpatient surgery under anesthesia. they have to have everything in place and set up with nurses, etc...prior to surgery even beginning. they can't just customize a special protocol for everyone. geez. i was able to test my blood sugars, I had my meter...they didn't care, no one stopped me but I was useless to do it properly. you start before the procedure with the IV drip of insulin and glucose and whatever they're giving you, fluids, antibiotics, etc.., it's already there, there's no waiting for anything. it keeps you alive during and after the procedure.
During my surgeries, a set up a specific schedule of basal rates, lower than my usual to cover that sort of thing. Granted I also have the benefit of a CGM to alarm if need be. So far I've done it right. I stayed in range (for me high the whole time 120bg) but it worked.
