Not Worth the Argument

Type 1 and LADA
#1

I was on the phone with a nurse doing a pre-surgical inventory. Basically, it's running through a checklist and answering 'yes' or 'no'. We'd already gone over the fact that I had an insulin pump and it gets to this point:

Nurse: You're taking insulin for diabetes.

Me: Yes.

Nurse: What type are you?

Me: One.

Nurse: Juvenile onset or Adult onset.

Me. Adult.

Nurse: So you're Type II.

It's not that I'm offended to be called a Type II - it's just that this medical professional jumps straight from 'adult onset' to Type II, completely ignoring the what I'd told her moments before and substituting her own diagnosis for that of my endocrinologist.

But it wasn't worth fighting over.

Sheesh.

#2

Agreed…

#3

Geesh! How do we expect the public to understand the difference when medical people don’t?

Agree with Tom & Sarah. I’d want my medical file to be accurate.

When I was hospitalized my roommate was T2. Nurses were checking my BG more frequently. We got the same crappy meals, though:)

#4

And Terry , do the surgical staff know, the protocol and procedures of keeping your pump going , while in surgery ???..
Where I live , the pump maybe disconnected .

#5

It is worth the fight, she needs to be educated about the fact that adult onset doesn’t mean type 2 by default. They are different diseases and they are managed differently. Make sure your chart is correct and they know how to manage your diabetes while in surgery and in recovery.

#6

Yeah, I would’ve argued. lol Never let people stay ignorant, if you can help it. lol

#7

It is not worth it. Lets consider the issue for a second. you use insulin, and they will need to treat with insulin. Who cares how you got there? I am type 1 and my doc thought I was type 2 for years. So, who cares really what i was, what i am is far more important.

rick philips

#8

Oh i am nto saying it is right to ignore it, I just do not tend to discuss such issues with people who obviously do not know.

rick phillips

#9

I had some thing similar happen to be but it involved a latex allergy.

Nurse: Are you allergic or have ever had a reaction to any medication?
Me: Yes Percodine…
Nurse: what was the reaction?
Me: Vomit, lots of vomit, and I react to Humalog.
Nurse: Humalog?
Me: yes Ma’m, I react to the rubber solids from the stopper. I have a latex allergy…
Nurse: So you never reacted to the insulin?
Me: (looks her dead in the eye)… I broke out all over my body, i switched to Novolog and it cleared, so yes, I did react.
Nurse: But…
Me: You will have Novolog, and Glucogen not Humalog and Glucagon on stand by. Or let me speak to an Hospital administrator and legal council.

Luckily it was sinus surgery and it was my ENT who Dxed me and was doing the cutting. Unfortunately despite the large sign above my bed the tech would pull latex gloves out of her pocket when she took my vitals.

#10

It is very much worth the effort to make sure she records the correct information and that she does not provide incorrect information to other medical professional who may be treating you…and who’s knowledge and understanding of your condition may save your or kill you.

My mantra is to NEVER let a medical professional whom I come into contact with, conscious or unconscious.

When I go under for any reason, I meet with the anesthesiologist, the knife, and talk to the OR nurse before I go under. They all have to hear my story and how they can best support me during the medical procedure.

#11

What I should have said is it wasn’t worth fighting over ‘at the moment.’ I figured I could clear it up on admission.

In fact, you’re so insistent that I’ll make sure of it.

It’s an outpatient procedure, btw. Another reason I wasn’t going to get into it with her.

But, thanks for keeping me on the straight and narrow.

Terry

#12

Maybe you need to have in your chart that the pump stays on unless you or your endo decide otherwise to ensure that they’re in the loop.

#13

You’re right, I would have argued. It may not seem important and many times it’s not but not being a medical person, I don’t know what could come back to bite later on! Plus, I’m not sure the people who take your information are nurses, I think they’re just information takers following a list of questions that may need updating.

#14

The hospital staff might not know the difference between insulin treatment for Type 1 and Type 2, but it is a hugely important distinction. If I were to get put on the “sliding scale” for Type 2 and get injections of the magnitude that they give many Type 2’s, it would send me into horrific lows and possibly kill me. So your comment that “you use insulin, and they will need to treat with insulin” is terrifying to me. They need to know how to treat me with insulin.

#15

She was doing this pre-surgically, so she’s hired in the outpatient surgical department. The outpatient surgeon/anesthesiologist head needs to know that diabetes is an area for inservice needed by their nurses. I kid you not. Protocols have changed while these people have been working. It’s worth mentioning every time we run into someone who does not know something. Every time. If they don’t get it from “patients,” they’ll never get it. I cannot urge you all enough to speak up when you are with health caregivers…
And furthermore, write down the protocol you want for your pump while you’re on the cart, and give it to them. Finally, the anesthesiologist on call will take note, even if you don’t need anesthesia.

#16

Matthew- I had a similar experience while in hospital for Dka. They had Lantus and Novolog on my chart. I freaked out. I said: “Where did you get this information?” They said: “Your chart.” I pulled my chart and it read “Levemir and Humalog” She said: “It’s the same thing, ma’am, relax.”

In lieu of strangling her, I put on my stern face and set her straight. “Lantus puts me into insulin shock comas. Novolog takes HOURS for it to work on me. You will get my medication right, or you will allow me to administer my own medications by syringe- not this IV crap you’ve got me on.”

I hate being in hospital. It’s really scary putting my life in danger with their lack of training. I’m there to get better and most times I end up more sick. Scary.

#17

Hi Terry,

If it’s an outpatient procedure then it really might not matter.

But in other cases, it does. When I had an appendectomy (before I was on the pump), I took my Lantus as usual the night before (I took 10 units a day and was very insulin sensitive). After I started to “come to”, the nurse came in to give me an injection of 6 units of regular, but i was not able to eat. She told me that this is what they do for ALL DIABETICS. I didn’t understand how they could have a universal insulin type and dosage for all diabetics, but they did.

I protested saying that I don’t take that type of insulin and that seems to be WAY too much for me. They insisted and came at me with the needle. I basically ended up kicking and screaming and told them that I would let them give me the injection after they called my endo (in the same hospital) and got her to approve it. They called the endo’s office and someone came immediately to write on my chart “Patient delivers her own insulin.”

For those going in for surgery, I recommend getting your endo to insist on that before the surgery. It would have saved me some headache and maybe the nurses would not have referred to me as a “defiant” patient :slight_smile:

#18

I think this is where the frustration of the never ending saga of typ 1 or type 2 comes from. I think medical professionals themselves do not educate themselves on the difference of the two. We our selves know what we are but others who should know dont. I think if there are more type 2’s out there we should be the advicates for type 1s. When I talk to people and they ask me about my diabetes I explain the differences between the two. I think its worth the argument that if hospital staff does not know what they are dealing with how do you resolve any issues? I would call back the hospital and speak with someone about this. You could always inlist the help of your tudiabetes friends and we could flood the hospital with calls to tell them the difference between type 1 and type 2. Maybe if they get enough calls they will realize that it is import to know the difference between the two types. i would be game to give them a call and explain the difference.

So our issue is not our community and the difference between the two but those outside who should know and not know

take care

#19

Personally, I would correct this mistake. The nurse’s medical history will probably override an endo records as far as background for your surgical procedure. There is such incompetence in the medical field that you may be assumed to be an insulin resistant diabetic and have insulin withheld, pump or no pump. How would you like to wake up and be told they disconnected your pump and that you went into DKA?

As far as the nurse is concerned you have “Juvenile Onset Diabetes,” you just got it as an adult.

#20

I would absolutely make sure that both the surgeon and the anesthesia provider are clear on your diabetes management. I spent years working in an operating room and have seen many T1Ds on pumps on the table for surgery. Depending on the type of procedure you’re having, you may or may not be able to keep the pump on during the procedure. Also, and very important, is that the type of anesthesia you are receiving may affect your insulin requirements. The only other people who may be involved with your insulin dosing are the post-operative nursing staff, so type something out ahead of time about your medications and your pump, especially if you expect to be out of it for awhile.

As a side note to your original point on health care workers knowledge about diabetes, please take my advice and trust no one. As a T1D who is also a midlevel provider (or VERY soon to be) I am AMAZED on a daily basis, not on the lack of understanding, but the presumed understanding. That is, its not that health care workers don’t know about diabetes, its that they THINK they know about diabetes when they clearly do not. Most, but not all, of the nurses you will encounter in the hospital know very little about diabetes mgmt (unless they work in endo). And the knowledge only barely increases as you work up the clinical ladder to physicians. Just today, a supervising family practice PA spewed such a torrent of nonsense on diabetes to a diabetic patient I was seeing that it was all I could do to keep my mouth shut (it wasn’t affecting his ultimate care, so I didn’t bother).

Sorry for the long rant, just home from clinic and had to get that out!