Pumps and hospitals

I never had problem, only positive responses, but mainly due to my CGM (which now is part of my pump (Vibe)). I’ve been pumping a long time and if/when I had/have a procedure in the hospital either as in or out-patient I abide by the no eating after midnight. I always schedule my procedures/operations first thing in the morning.
I let everybody involved I do not want them (operating room personnel) to touch my pump while under the knife.
Talking to the surgeon and anesthesiologist explaining that I know what I’m doing and showing them instant read outs of my BG numbers and trend convinces them I’m OK but they will always say that they might override what is happening when needed. I’m okay with that.
Going in and showing the surgical staff that they can look at my BG showing where it is going and not that it is a number in time. I haven’t had one yet that didn’t say “I wish all our patients had something like that”. All of them are interested and I show whomever needs to know how they can bolus if needed and the IV can handle the glucose when needed.
In the 5 procedures/operations I had done while pumping everybody is in awe and love the pump and CGM. Of course lately the medical staff is more aware and know the devices more so then 5-10 years ago.
As for food I order of a menu (I don’t let the hospital determine what I eat), knowing my carb values and I’m always the only one in the post op room that wants and gets food. So far so good.

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I had a 4 day hospital stay while on MDI. Was told not to bring my insulin then found out they didn’t have U500. Was given U100 instead which is very inconsistent in big doses. So BG control was out the window a few days. Luckily I never went over 250 but not good results. Next year I had a 3 day stay. Since I had now learned to ask ahead in pre-op and because they did not have my insulin in their pharmacy, the hospital agreed to let me keep my kit after I happily signed that I’m responsible for my own dosing.

But WOW when I was then transferred to a rehab center for 4 days on a Thursday, they freaked that I had my own insulin and syringes. My GP (not endo) wisely stopped by on day one and signed orders to reduce my twice daily dose by 25% since they had to bring me the syringe and could not bring me any dose other than THAT ordered amount. Didn’t matter what my BG was. When it started running low on day three, Sunday, I had to drink a cup of OJ per hour for several hours because no matter what, I was getting that full dose of insulin. Hadn’t drunk that much OJ in 20 years (too bad there was no vodka around…). My GP (who is the best GP ever) explained that the Nursing Home/Rehab Center runs under different rules than the hospital. Luckily I was walking well enough to go home on Monday. The Rehab Center even told me on day two (Friday) that their Dr would review my “treatment plan” on Monday and change my insulin. True enough it didn’t help that I use U500. Now I have a pump but no CGM. Thankfully no hospital stays on the horizon but I surely have learned that I will ask ALL the players up front and I want any agreements or clearances in writing.

As I think through the possible scenarios on pump use while you are under medical care, the thought of someone else making my dosing decisions with my pump, basal or bolus, because I can’t or the rules won’t let me scares me a bunch! The Omnipod (btw having great results, last A1C 5.5 :sunglasses:) has NO setting for an IOB not to exceed upper limit. There is nothing to prevent over bolusing. There is a limit on a single bolus but nothing to prevent nurse 1 giving you a bolus and then 30 mins later nurse 2 giving you another because bolus 1 was not on your chart and they don’t know how to lookup bolus history and they have no approved protocols for operating pumps. I’m curious if other pumps have an IOB upper limit setting to prevent overbolusing as I see this as a hole in Insulet’s software. Based on what I experienced in my short term stay in the nursing home setting, I would be taking the pump off before I get in there.

I’ve read the policies at the hospital near me. If I were to ever be hospitalized, I would not agree to anyone managing my bg while alert and oriented. Should I need surgery, the anesthetist and I would have a detailed chat about cgm and pump… I have not met any nurses who are familiar with insulin pumps and cgm. I know there is an endocrinologist on call so should I need to be hospitalized, the staff can call that person with their issues. And I would be requesting a consult from the endo on call asap before I agree to anything. I do all my own diabetes management. Always have, always will.

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@Suzan, The pump makes them nervous. I’m in the U.S. They want to be in control of ALL medications.

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My endo trusts me and praises my results when I meet with them. So I won’t be handing over control to some stranger who doesn’t have a clue about T1D or CGM or insulin pump. I am familiar with my insulin and how it affects me. They are not. I see what happens when people who mean well screw up. I suppose if I were letting the doctor decide my ISF and ICR and basal rates then I would gladly let them do as they please… but that is not me.

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How is this helpful? Is the presumption that the patient’s current site was placed by someone else? Wouldn’t asking if the patient does their own site changes be enough?

I think that competence of changing the site gives insight into the patient’s current cognitive, visual, and tactile abilities.

Given that turn-about is fair play, if the hospital proposed to take over my insulin regimen while I was still competent to do so, then I think a demonstration of a basic understanding of insulin therapy by hospital staff is also appropriate.

I think they should readily know the onset, peak, and duration of the insulin they propose to use. They also need to understand the pre-bolusing tactic and why it’s used. An understanding of dosing mealtime insulin based on carb consumption should also be demonstrated. A good familiarity of the concept of insulin on board or IOB should be tested.

I would expect resistance, resentment, and rejection of this suggestion but perhaps they might view my abilities in a different light given these basic insulin therapy questions. Since doctors order medications and dosages in hospitals, I’m thinking my idea would not gain much traction. Doctors are gods, after all!

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I like your approach better. Caleb was able to change his site when he was very young…maybe six or seven. He by no means had a competency to manage his dosing at that time. The test of changing a site gives false security.

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You’re right, of course. Hospital staff could not infer dosing competence using a site change test in every patient. I think a short conversation regarding the technical aspects of insulin would help them.

didnt mean to post, oops

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I agree with all that has been said. A while back I was in the hospital which now uses only “hospitalists” rather than a person’s own doctors treating him or her. My glucose started to run into the 180 range. The next thing I knew, a nurse entered my room with a syringe full of insulin. I asked how much was in the syringe. She said that the hospitalist ordered 25 units of regular insulin to combat my high blood sugar. (The hospitalist had not been in to see me or to talk with me at all.) I told her if I took that much, I would be dead by morning. I and SUPER sensitive to insulin, so I showed her that my pump calculated that I should take 1.85 units to combat the high. She said, “So you are refusing this injection?” Dah! “Yes, I am refusing that injection,” I said. I then took the 1.85 units through my pump, and an hour later I was down to the low 100’s. So yes, ALWAYS be your own advocate or have someone with you who knows how you react to your pump, medication, exercise, and food. And always question everything that they want to give you. No one knows your body or your DM better than you do.

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That is insane !!!

Good thing you stand up for yourself.

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Yes. The hospitalist would have killed me. While I realize that some people would NEED the 25 units, I also realize that such a dose is lethal to me. When I told my Endo what the hospitalist tried to do, she said, “Always tell them to call me as a consultant on your condition. Most doctors do not mind a consultation with a specialist.” I always have her number and that thought in mind when I go into a hospital now.

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I had surgery several years ago. I contacted my endo who sent orders to hospital to allow me to manage my own insulin, with pump, after recovery from surgery. During surgery I had IV insulin and frequent BG checks. I had to remove pump and CGMS due to the surgical procedure. They continued IV insulin for about 24 hours, while I was medicated for pain and slept most of the time.

I did have to sign forms, and have twice a day visits from hospital endo, and answer any questions regarding my abilities to continue self care. I had my pump and started a new sensor. Many of the staff asked questions, and I was happy to explain how they worked.

I think it’s important to get your endo involved as soon as you know you will require hospital stay.

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Yes. totally insane, Any idea of where they got the number of 25 units? Do they have any clue that they are clueless?

Unfortunately the medical field really doesn’t teach much about diabetes. My step sister is a nurse and didn’t understand the difference between type 1 and type 2 and said I could control my blood sugar with diet. I have heard the same by many others, even doctors. You are lucky if they know the difference between type 1 and type 2, and it is almost a miracle if they understand dosing and everything else. Type 1 management is something severely lacking in training.

Staying in the hospital and having to rely on them for management or having surgery (or anything else leaving me unable to make conscious decisions) terrifies me. They think they know so much, yet know so little that it is just a mistake waiting to happen. The last time I was in the hospital was after having a severe hypo event, which afterwards I shot up really high. My wife felt I should go to the hospital anyways just to be safe, so I did, and of course they wanted to keep me for a few days ($$$$). I didn’t have a CGM at the time (this event is also the reason my endo told me to get one), and I think they wanted me to not use the pump so they could control everything and monitor it. I thought that sounded fine at the time. The meals they had for diabetics were not super high carb, maybe 30 at most I believe. They checked my blood sugar with their giant freakin meter that has a scanned to scan your arm band and stuff, and then would give me shots of humalog. No basal insulin, and they didn’t do pre meal boluses either. They also didn’t ask me any of my settings/ratios, but I think they may have called my endo and asked (granted it can change from what he has on file…). They did manage to keep my blood sugar stable, which they said was their primary goal, only they kept it stable around 300-350. I was so glad to get home and use my pump and get my blood sugar down to normal. Stories of nurses trying to give 25 unit boluses for BS inthe 180 range…that is the kind of thing that freaks me out. What if you weren’t conscious to tell them they were about to kill you?! Goodness knows they don’t use any kind of continuous glucose monitors, and any other alarms that go off take them forever to respond to so if your BS plummeted you would probably be dead before they got to you!

AS a side not, I had to look up what ISF stood for, as I have never heard it referred to as that. I have always heard and referred to it as correction ratio.

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