Recently I was admitted to the hospital. Somehow I think my pump was almost more of issue than my high blood pressure.They asked and asked, looked at readings in pump (basal, etc.), and then looked again. When it came to
ISF, I couldn’t answer her question, so she mentioned that if it wasn’t figured out, they might have me stop pump and
do shots. I mentioned leaving hospital AMA (Against Medical Advice). It was as though they had to know everything
about my pump. Jeeze, it is a smart pump and I have been doing just fine for eight years. Last year, I spent time in
a Korean hospital and the medical folks there assumed that I knew how to do it.
My other issue with hospital was the diet plan for diabetics, They assumed 60 grams carb per meal. That would be 180 carbs/day! Nope, not me. My breakfast consisted of scrambled eggs, piece of ‘french toast’, box of cereal,piece of banana , skim milk and artificial syrup. I ate the eggs and told someone, “I am not going to eat this #&#&” Later did drink milk and took banana to eat before echo/cardio treadmill test. Before I left, the dietician came to see me. I asked why four out of five breakfast items were carbs (and mentioned that the box of cereal which their menu was listed as 15 carbs was 22 carbs on the side of the box, She decided that I knew enough and left.
I would like to hear some stories from others about pumps and diet in hospital
I had some issues like this. Last time they let me do everything but tested my Bg- I think I used my meter too to compare. Yes the 60 g per meal yep I said no to that too. I explained to them that I never eat that many carbs per meal and due to crashing Bg I’d had to lower it to take smaller boluses. They accepted that but there were questions and a visit from the dietician. Even though I wasn’t eating all of it I had to order a certain amount of carbs anyway. She seemed to understand. I told them no gluten though and I did get some gluten in a sauce which made me worse. I shouldve picked the totally gluten free menu.
I agree that a pumper should know their ISF like the back of the hand. (seriously)
Some hospitals I’ve been in (pre/post surgery) have been horrid to deal with in regards to my DM treatment. And that was prior to being on a pump.
When a patient is “out of it”, ie too much morphine to be fully coherent, for example, hospitals don’t want you self administering insulin via pump or shots. Makes sense.
If a patient is undergoing surgery, they can keep the pump on and running, if the anesthesiologist is on board with that. I’ve done that lots of times for surgeries.
But again, you really, really need to know what your ISF is.
I do know my ISF, it is even in my pump, but I couldn’t figure out what she was asking. She seemed to want some kind of formula to understand why/how the pump knew what to do. I don’t see, since I was not going to surgery and not passing out, why they made such a fuss about mt different basal rates. I did this three times. Made me wish that I was back in the Korean hospitsl
I was in no way 'out of it", I took no pain medicine until middle of night when I was given morphine. By morning it was out of my system.
It’s interesting to me how often this happens. And I just happen to me last month when I was taken to the hospital for what I thought was a heart attack. And while I was not admitted, they wanted to keep me over night for more tests/observation but I was told I would have to remove my pump.
I told the CDE they sent in, that there was no way, I was taking it off and if they demanded that, I would check myself out,as early lab work said, I didn’t have a heart attack.
Of course they panicked and didn’t want me to leave. So 15 minutes later, she was back with forms stating the hospital wasn’t liable for blood sugar issues. Ok, by me since I do this everyday all by myself. The sad thing was the form I had to fill out. It asked what my bolus was for each meal. So I put my carb ratio for each as each is alitlle different. But than a few questions later it asked for my carb ratio. I told the CDE that their form is way outdated. And she of course agreed but she said at least they have a policy for allowing me to keep it on.
So I did keep it on and thank goodness because during the night, I started running low and wasn’t able to eat until after my stress/echo the next morning. But using a pump, I just suspended it for an hour and things worked out perfectly.
I also agree that the diabetic/cardio diet leaves much to be desired. I could have handled to more carbs, if I had been aware of numbers before it hit the table. Hate not being able to pre-bolus.
Scary thing, this is a major hospital chain in the county I live in but no endo on call at this hospital. Live and learn.
I’m on MDI, but my daughter works in the medical field. She told me NEVER to let the hospital take over control on my blood sugar. I have been hospitalized a few times. I do all my own diabetes care.
I raised this issue with my endocrinologist earlier this year. She said that the hospital that she is affiliated with wants to know that the patient is competent in using the pump. As a way to demonstrate this competence, the hospital staff requests that the patient do pump site change.
This seems a little short of the real competence (showing and understanding of I:C, ISF, DIA, as well as insulin onset, peak and duration) but I understand their rationale. If a patient can comfortably perform a complete set change then that infers that they know a lot more about how the pump works.
No one can control my blood glucose levels better than I can, provided I am conscious and maintain cognitive, visual, and manual dexterity function. I understand the hospital’s clinical and legal concerns but once a patient demonstrates diabetes competence, the hospital needs to respect and work with that patient to produce the best outcome. I will never let any medical person pull “medical rank” on me because what I know about my glucose metabolism dwarfs their knowledge.
If someone wanted to challenge me about my competence to control my diabetes, I would likely strongly push back and start asking them some questions to challenge their clinical and medical knowledge. Something simple, like, “Describe what a pre-bolus is and when and when not you would use it.”
I was at the emergency room a few years back with a stomach bug. They were giving me glucose and a pain reliever to break the fever. I was really out of it, but I don’t remember two words about my pump. I found it really odd.
The reaction to my CGM during my colonoscopy was disheartening. They went to put a blood pressure cuff on my non-iv arm.
“What is THAT?” (I had my sensor on my arm).
They thought I was from outer space (and they put the cuff on a leg). They had never heard of a CGM.
The one thing I had to do was yell for a nurse. Right before the procedure, I took a BG reading and I was plummeting (in agreement with my CGM). I told her I needed something to keep me from going low. She got a bag of Dextrose and I could let the fentanyl (!!) take me away.
ISF is something that can be affected by any number of things and while our pump contains a number, we all should know from real life that it’s just a number. What an interesting rule and demand that if you don’t figure out your ISF they might stop your pump, and fussing over your different rates. I’d leave with you Suzan if they tried to stop your pump. I hope you are doing okay.
When I went for a colonoscopy, their meter reading (high) of my blood sugar was way different than mine (low). I mentioned this to the doctor and told him that I had taken my BG three times (all were approx the same) and that I trusted my meter more than theirs. He went with my reading, said a bit high for procedure was better than goimg low. and hooked me up to IV with glucose
I am fine, tests reveal no heart attack nor clogged arteries. Some concern over blood pressure (220/110 at fire station) but now have med.
Just have to mention the funny thing that happened on the way to the hospital…the ambulance broke down. We just laughed while waiting for a replacement.
I’ve been fortunate that I’ve always been left to manage my own diabetes in hospital. Once I had to let the nurses know every time I tested, ate, or took insulin, but they said they would only take over control if I were to go unconscious or otherwise be incapable of handling it.
I agree that the diet is terrible. I have food allergies and they handle those well, but the meals I have received have been almost entirely carbohydrates. I’ve had my parents bring in food for me so that I can eat that instead of the food the hospital serves.
I have seen the menu choices for breakfast. On every breakfast tray there is a menu from which to make the next day selections. No more than 60 carbs/meal. So, to get it up to 60/meal, because I hadn’t been there the day before to make my selection, they chose piece french toast, box dry cereal, and banana. I aim for 40-60 cars/day, but actually eat 50-75.
I’ve never had the opportunity to choose meals. I’m not sure if that’s just because things are different in Canada or maybe it’s because I have food allergies. Last time I was in hospital the only protein at breakfast was two slices of bacon. Everything else was carbohydrates. They also never seem to select a “diabetic” meal for me it always said on the sheet that it was a normal meal, but it did list my allergies, so I think probably I get a customized meal rather than any standard choice.
Fortunately, our local hospital (as I found out when we were “inside” for seven days during a horrifically difficult delivery of our son last year) actually has a low-carb menu for patients and visitors! Amusingly enough, they hate giving it to diabetics (I think it’s actually intended for epileptics and those recovering from certain kinds of bariatric surgery). I actually had to convince the OB and pediatric nurses (who knew I was a diabetic…joys of living in a very small town) to bring me the keto-diet hospital food, because they were convinced I’d die of acute hypoglycemia if I didn’t have that 45-60g of carbs per meal and 15g per snack…
The reality is, institutional medicine in the US (maybe elsewhere?) is as terrified of insulin therapy and low-carb eating now as they were forty years ago, despite the changes in technology and medication. Why? Because they worry more about the liability involved in someone dying from an insulin reaction than the long-term damage done by a day or a week or even a month of running high BGs. Their preferred method is pretty simple: inject insulin on their schedule and feed a moderate carb diet so that the patient runs what many of us would consider high BGs in the 140-180 mg/dL range. That way, they don’t have to worry about preventing or treating lows.
I’m more and more convinced this is one of the reasons so many doctors and medical professionals resist the idea of “tight control.” They worry far more about acute risks than long-term risks, because that is the nature of the way they treat 90% of medical issues (for good reason). They just haven’t caught up with the technology and improvements in insulin therapy over the last twenty to thirty years.
Why? What is their explanation? Also, where are you geographically located? As I stated previously, I was hospitalized in Seoul, Korea, and they assumed that I knew what I was doing. I think there is an attitude in this country, that as patients we could not possibly have any idea about our own health. I remember telling a new diabetes doctor that I couldn’t take some meds because I had elevated liver enzymes. He said, “I don’t know that you have eleatedl liver emzymes” and gave me a prescription counter-indicated for those with liver issues. Having had a liver biopsy to find cause of elevation, I knew but he just dismissed the idea that I knew anything about my own health.
I think in your country there is also a high tendency to litigate. If the hospital is not directing your diabetes care, and something goes wrong or you die, the hospital is liable. In such an environment, they may not wish to take any chances.
I have never had any problem in a Canadian hospital. I tell them I am Type 1 and using an insulin pump, and they seem happy to leave things to me. And if someone did ask questions to verify my competence, or a dietician was sent to interview me to make sure I knew what I was doing, I wouldn’t be offended. I would assume they were just protecting themselves from any possible legal repercussions.
I was in for a one-day kidney stone procedure recently. While I know this isn’t nearly the same as being hospitalized for an extended period of time, I WAS impressed with the anesthesiologist. He talked to me, looked at my CGM data to corfirm that things were good, told me that he would not run a glucose IV while I was under (which, I gather they often do), but asked me if I would dial back the basal rate to 50% for the expected duration of the procedure. I was happy to comply …
So, some get it …. Note: he was 30-something, so probably more up on things like pumps and CGM than many “more experienced” physicians.
Thanks for this discussion … it will help me to be better prepared …
My real issue was not that they wanted information, but seemed to want an explanation as to how the pump calculated stuff. I know my information, but also that it is considered to be a ‘smart pump’. I do not know the whys of a complicated computer, Pumps are very expensive computers, I give it info, and using the settings put into it, it does the calculations. Actually, I think that quite possibly , she didn’t know what to ask.
yep I said no to that too. I explained to them that I never eat that many carbs per meal and due to crashing Bg I’d had to lower it to take smaller boluses. They accepted that but there were questions and a visit from the dietician. Even though I wasn’t eating all of it I had to order a certain amount of carbs anyway.