Surgery and hospital stays

I just had to share this experience with people that understand (and this is REALLY long!)…

On Aug. 23 (Saturday), my husband and I were in a bad scooter (same size and power of a motorcycle) accident here in Italy. The first thing I remember yelling when we were on the ground is that I have type 1 diabetes and an insulin pump because my biggest fear was passing out and having no one know (even though I wear a medic alert bracelet, they aren’t used here). As soon as I was in the ambulance, I asked an EMT to check my bloodsugar because I felt low and he told me that some one would check it at the ER. In the ER, my bag was on the stretcher with me and after asking everyone to please check my bs and having no one help me (I also kept telling every person I saw that I have type 1 diabetes and and insulin pump), the xray tech held my meter while I poked my finger and did everything on my own (this was 2 hours after the accident and 1 hour since arriving at the ER). At that point, my bs was in the 200s and I didn’t correct - I obviously knew my body was under major stress and had undergone a huge trauma and never having been in a situation like this before, I had no idea if I would go high or low. When went to have my arm casted and my leg put in traction, the doctor and nurses asked me what my medic alert bracelet was because they had to cut it off. I explained it to them, and they thought it was the smartest thing ever…why are they not used here?!

I survived the ER (broken right femur, ankle and hand) and was moved at 2 am to my hospital room. Once again, I told the two night nurses (2 nurses for 140 patients…) I’m diabetic with a pump and they said ok. I asked if they could test my bs, no. Friends came by at 2:30 am and they ended up helping me…

Sunday my husband was moved to the same ward I was and since I couldn’t move, he would come as often as possible to help me test (it was interesting…we both only had our left hands). No one came to test my bs at all or try to figure out what I was doing for insulin…my dad (a physician who was my biggest advocate through the whole ordeal) arrived on Monday morning and at that point helped me change my site and took over the bs duty. I was to have surgery on Tuesday, and that afternoon, my anastheseologist came by to talk to me. He didn’t even know I was diabetic or had a pump, and after talking to him and finding out my surgery was going to be long and major (how long? how major? they dont’ tell patients because they don’t want to scare them…) he told me I could keep my pump on and he would test my bs every hour. No mention was made of what to do to correct if I was high or even what the target range of my sugars was (I was too out of it to even realize this until he was gone).

Tuesday morning, a nurse came and checked my bloodsugar for the first time!!! They also told me I was going to be hooked up to an insulin drip/pump via IV for the surgery - I told them this wasn’t what the anastheseologist and I had decided, and she basically said too bad. She did tell me that after 24 hours I could be hooked back up to my pump. I was going into sugery at 10 am, so at 7 am they took my pump off and got me going on the insulin via iv. The surgery lasted 6 hours, and by the time I was out I was taking 8 units an hour as a basal rate.

I was brought back to my room immediately after surgery where my dad and husband were waiting. The nurses were supposed to check my bs every 2 hours and they had a sliding scale for basal rates to follow that included nothing for corrections - what ended up happening was that my bs slowly increased throughout the night from 250 to 350, but according to their sliding scale, they couldn’t change my basal or give me anything for a correction. I tried telling them that 12 hours of my having numbers like that really makes me feel really, really sick and obviously their plan isn’t working, please call a doctor because I need more insulin, but they never changed anything.

All Wednesday I asked for them to please call an endocrinologist and that I needed more insulin (even though it was incredible for me to believe that I was taking so much already). Two endos ended up coming up that evening, but not because they were called - they had heard a young American diabetic woman had been in an accident and had gone through major surgery. They told the nurses how to better manage the insulin iv and they made a better sliding scale that included correction boluses - however, this was not passed on when the nurses changed shifts and it turned out to be a repeat of Tuesday night.

In the end, I was hooked up to the insulin iv for 8 days because my needs for insulin stayed incredibly high. When people talk about keeping their pump on for surgery, after what I went through, I would never do it (even though I went to hell and back with the nurses). I dont’ know if it was the length or severity of my surgery or just the general trauma to my body, but none of us were expecting me to have a basal of 8 units per hour at the end of surgery (especially not my dad who operates on patients and lets them keep their pumps on).

The whole experience was awful - once I was back on my pump, nurses would constantly tear my sites out because they “didn’t know what it was”. When I was still on the insulin iv, I would be told to eat and after asking for insulin first, they would say, “No, you eat, then after an hour we see what your bs is and then we’ll give you insulin.” Needless to say, I didn’t eat until they would give me insulin FIRST. When I was hooked back up to my pump, my carb to insulin ratio had gone from 1 unit:12 g pre-accident to 1 unit:3 g (another shock…).

After 17 days in the hospital, I finally came home and am slowly working everything out diabetes-wise. This has been such a test of patience for me, and I think that going through all of this has taught me so much, both about my body and its needs and diabetes in general. The past two days are the first that I have been able to be some where other than bed or my wheelchair and it’s these small things that I am just so thankful for.

I had a comparable experience in a hospital in germany 17 years ago. In a bike vs car accident I nearly lost my left leg. I take shots and my glucose went through the roof for three weeks. My family called the hospital where my diabetes was diagnosed. The personal there was so kind to visit me. But that day was a bad pick since the hospital transferred me to intensive care and put me on a insulin pump. A pump is nice if you know how to handle it but they had no clue about the treatment of diabetes. The knowledge about carbohydrates in food was lousy and I even had to argue that my NPH insulin just lasts for 12 hours and not 24 hours like my surgeon insisted before they put me on the pump. After two days in intensive care I insisted be put off the pump and to regain control of my diabetes.

I would say that the excessive increase of the glucose level is normal with traumatic injuries. But the helplessness of the whole staff was and is unbelievable. Today the situation may have improved in germany since many hospital have now specialized departments for diabetes care. 17 years ago only few hospitals had the knowledge to treat type 1 diabetics.

It makes me really sad that even nowadays you two had to make this frightening experience of being left alone. I wish you all the best for you and your husband and a good recovery from your injuries.

Kirsten, I’m so sorry! An accident is a scary enough experience without all that mess! I have been wondering where you’ve been. I am so sorry that happened to you guys.

I had a bad experience with nurses and pumping when I had my appendix out at age 21. They refused to give me my pump and my sugars were in the 350 range post-op. At the time, I really didn’t know that a surgery could produce high blood sugars, so maybe having my pump couldn’t have avoided those levels (an 8 unit basal??!), but I really felt they weren’t doing enough to bring my blood sugar down. I had to call my endo to come rescue me and he made them give me my pump and allow me to resume control of my own insulin dosaging. Your experience (and thank you so much for detailing exactly how your insulin needs changed) will hopefully help people here be advocates for their own needs should trauma befall them. I love how you told everyone over and again that you were diabetic. I admit I haven’t worn a bracelet in years. I’ve been too complacent. blush

Thanks for letting us know that you and your husband are okay. You’ll be in my thoughts.

It’s so nice to hear about other people’s similar situations and to know that life isn’t going to be like this forever! I would say that medically speaking, Italy is very far behind the rest of Europe and the U.S. It really was amazing when I asked nurses about grams of carbohydrate in food, they had no idea what I was talking about (thank god I’m ok at eyeballing food!) and they kept trying to give me sweetened tea to drink. At least I’m home now…


What a nightmare! I hope you and your husband recover speedily.

Even in the U.S. hospital staffs and doctors can be very clueless. I went to the hospital for a stupid accident last year and the ten year old blood sugar meter they had was so innaccurate, the nurse wanted to treat me for a “hypo” when I was at 110 mg/dl.

The doctor in charge lectured me about how important it was to eat a low fat (high carb) diet and because I had diabetes written on my chart they tried to railroad me into having extremely expensive heart tests which had nothing to do with why I was admitted.