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Diabetes and the Hospital

E

Educator123

Member
Messages
22
Location
London
Type of diabetes
Other
Treatment type
Other
Hi all

My name is Susana Rodrigues and I'm a nurse working on a private hospital. I have a special interest in this subject and I'm currently revising my hospital Diabetic Policies and Procedures according to the NICE Guidelines. I'm particularly interested in knowing your experiences when u were hospitalised for an elective surgery... pre-assessment phase, peri-operative phase and discharge phase! How did you manage your diabetes? Were u the first on the surgery list? How was it managed by nurses and doctors? Did you feel comfortable with the management you received? What would you like to see changed? Was it an overall good or bad experience? Please let me know as all contributions will help me to improve diabetic patient care :) Many thanks, Susana
 
For me personally, and you must bare in mind that we will all have different approaches in "assisting" our control of our BG levels, I follow a low carb diet so your NICE guidelines aren't suitable for my diet. Not all diabetics have the same approach so a one policy and procedure isn't going to suit all diabetics.

In the last 4 years I have been hospitalised several times, I had a serious internal bleed (after a colonoscopy), 2 knee replacements, a burst appendix and 2 suspected heart attacks, one here and one in the US. The good news is that my heart is fine and the U.S. hospital was after my insurance money.

On the three occasions where I had surgery, I was first on the list because of being diabetic and in case of "problems". My diabetes was really managed by the medical team and insulin was used only during surgery, I relied on my prescription drug, metformin, the rest of the time. I was happy with that. Food tended to be boring because I was excluding carbs as there were no low carb options. The diabetic options contained large amounts of carbs which might have suited someone on insulin.

Overall experience was good, low carb meal options would have been good.
 
I would say diet option of low carb would be an asset.
I was put on sliding scale in both times of giving birth incase cesarean was needed but the second time was not used properly by 30yr experienced midwife. A low carb diet with my own insulin injections would have been enough.
However in time of sterilization I believe I was on scale under general anesthetic. Day op and went home same day.
If I cannot inject myself I need scale. Low carb diet can reduce the amount of glucose and insulin needed.
I think giving patient choice will be an excellent way forward.
 
Having coeliac disease as well, I used to have real problems with hospital food.
Since I retired I've volunteered at our local hospital, and sometimes take my lunch break in the canteen which caters for staff, ambulant.patients and visitors. I've been pleasantly pleased by the knowledge shown by the kitchen staff - I just hope this has been taken on board by the kitchen catering for patients on the ward, but it seems they don't actually cook the food - they just warm up the ready to eat prepacked rubbish from huge conglomerate kitchens.
That explains why when I had an overnight stay they served me a plateful of lettuce and one tomato, no dressing or condiments - when I asked for salt and pepper I was told they were not good for me, and neither was mayo. I got normal jelly for dessert.
 
Hi. I've had several ops, two when I have been on insulin. Both happened to be at private hospitals. I was very pleased with the handling of my diabetes at both. Both pre-op asked about my diabetes and measured my HBa1C. They both tried to get me in for an early time in the theatre. In both cases I asked for and was allowed to keep and handle my own insulin. Nurses checked my bloods as well as myself so no conflict. I would have refused sliding scale stuff as I don't see the point and I've heard horror stories where the nurses don't know what they're doing and you can end up hypo. On both occasions the surgeon and anaesthetist discussed my diabetes and were concerned that it was handled correctly. My blood sugar was tested quite often post op by the nurses. As for food I just chose the more sensible low-carb foods from the menu. So, overall very happy with my treatment but it's important to let the patient manage their own insulin.
 
DavidGrahamJones said:
For me personally, and you must bare in mind that we will all have different approaches in "assisting" our control of our BG levels, I follow a low carb diet so your NICE guidelines aren't suitable for my diet. Not all diabetics have the same approach so a one policy and procedure isn't going to suit all diabetics.

In the last 4 years I have been hospitalised several times, I had a serious internal bleed (after a colonoscopy), 2 knee replacements, a burst appendix and 2 suspected heart attacks, one here and one in the US. The good news is that my heart is fine and the U.S. hospital was after my insurance money.

On the three occasions where I had surgery, I was first on the list because of being diabetic and in case of "problems". My diabetes was really managed by the medical team and insulin was used only during surgery, I relied on my prescription drug, metformin, the rest of the time. I was happy with that. Food tended to be boring because I was excluding carbs as there were no low carb options. The diabetic options contained large amounts of carbs which might have suited someone on insulin.

Overall experience was good, low carb meal options would have been good.
Click to expand...

Hi thanks for your insight. Very useful indeed! I agree with you when you say all patients are different. From my experience I still don't see low carb diets disseminated through our hospitals but that's something I intend to work on and develop. When you mean you had insulin during the surgery do you mean a sliding scale (they are now called VRIII)? When did they started and stopped it? Many many thanks again. Pleased to know you're well :)
 
Educator123 said:
Hi thanks for your insight. Very useful indeed! I agree with you when you say all patients are different. From my experience I still don't see low carb diets disseminated through our hospitals but that's something I intend to work on and develop. When you mean you had insulin during the surgery do you mean a sliding scale (they are now called VRIII)? When did they started and stopped it? Many many thanks again. Pleased to know you're well :)
Click to expand...
funnily enough this time last year I had my finger rebroken rotated and plated, which was classed as elective. I'm on an insulin pump and no one had a CLUE how to deal with me and kept insisting I should half my basal the night before and not eat anything until after my surgery at 1pm (first on the list).

Safe to say I refused to drop my basal and I stayed steady until about 11am when nerves started getting the better of me and I started dropping(a little bit not drastically), so they inserted an glucose drip and wanted me to turn off my pump. (thank god for my partner who kept me sane!)

So please, insulin pump training as well as CGM (no I'm not having finger sticks ever 15 mins! that's why I pay for CGM!)
 
Three years ago I had open heart surgery, my diabetes was managed very well and my diet was taken into consideration a great deal. I was in the QE in Birmingham for 7 weeks and have to say, I was very well looked after, particularly my dietary needs. :)
 
ickihun said:
I would say diet option of low carb would be an asset.
I was put on sliding scale in both times of giving birth incase cesarean was needed but the second time was not used properly by 30yr experienced midwife. A low carb diet with my own insulin injections would have been enough.
However in time of sterilization I believe I was on scale under general anesthetic. Day op and went home same day.
If I cannot inject myself I need scale. Low carb diet can reduce the amount of glucose and insulin needed.
I think giving patient choice will be an excellent way forward.
Click to expand...

Hi
I do agree with you when u say that patients should manage their own insulin but sometimes that's not possible due to the nature of the surgery or even the complications that might happen after. So the sliding scale (VRII) is the best option specially for diabetics on insulin and if the starvation times are long. But obviously for that u need competent and skilled people to manage it. Even with 30 years of experience you need to have at least yearly updates: clinical practice is always changing and evolving! And yes, all patients need to be involved in their care and clarified about everything that's happening during their stay in the hospital. Thank you for sharing your experience :)
 
ExD said:
Having coeliac disease as well, I used to have real problems with hospital food.
Since I retired I've volunteered at our local hospital, and sometimes take my lunch break in the canteen which caters for staff, ambulant.patients and visitors. I've been pleasantly pleased by the knowledge shown by the kitchen staff - I just hope this has been taken on board by the kitchen catering for patients on the ward, but it seems they don't actually cook the food - they just warm up the ready to eat prepacked rubbish from huge conglomerate kitchens.
That explains why when I had an overnight stay they served me a plateful of lettuce and one tomato, no dressing or condiments - when I asked for salt and pepper I was told they were not good for me, and neither was mayo. I got normal jelly for dessert.
Click to expand...

Hi
Lovely to know u can share your experience through voluntary work. I think that's truly amazing! Again, diet/menus for diabetics in the hospital setting are one thing that still needs a lot of work don't you agree? Thank you for your feedback :)
 
Educator123 said:
When you mean you had insulin during the surgery do you mean a sliding scale (they are now called VRIII)? When did they started and stopped it? Many many thanks again. Pleased to know you're well :)
Click to expand...

It was when I had a laparotomy (NHS) for what turned out to be a burst appendix and peritonitis, only seven weeks after presenting to my GP saying "I think I've got appendicitis". My whinge is about the system, not the doctor who had to refer me to a consultant (10 days), who sent me for a scan (10 days) and then I waited for the results (2 weeks) and then asked to go for surgery (2 weeks). Just as well my GP thought I had gall stones which were infected (high temperature and feeling like ****) because her antibiotics may very well have saved my life.

Sorry I digress, I need getting whinges off my chest recently, good therapy. I was given insulin while being operated on so I have no recollection of what was going on. I wasn't given insulin after coming round to my knowledge but my wife did say I had lots of tubes from different places, so I really don't know. I seemed to be OK when I had the two knee replacements (BMI), possibly because I wasn't ill. Hope that helps.
 
sarah_chadwick said:
Three years ago I had open heart surgery, my diabetes was managed very well and my diet was taken into consideration a great deal. I was in the QE in Birmingham for 7 weeks and have to say, I was very well looked after, particularly my dietary needs. :)
Click to expand...

Hello
So pleased to know u had a good experience! Can I just ask what type a diabetic are you? Type 1 or 2? Many thanks, Susana
 
Daibell said:
Hi. I've had several ops, two when I have been on insulin. Both happened to be at private hospitals. I was very pleased with the handling of my diabetes at both. Both pre-op asked about my diabetes and measured my HBa1C. They both tried to get me in for an early time in the theatre. In both cases I asked for and was allowed to keep and handle my own insulin. Nurses checked my bloods as well as myself so no conflict. I would have refused sliding scale stuff as I don't see the point and I've heard horror stories where the nurses don't know what they're doing and you can end up hypo. On both occasions the surgeon and anaesthetist discussed my diabetes and were concerned that it was handled correctly. My blood sugar was tested quite often post op by the nurses. As for food I just chose the more sensible low-carb foods from the menu. So, overall very happy with my treatment but it's important to let the patient manage their own insulin.
Click to expand...

Hi
Thank you for your message. It seems you were really well taken care off. I'm assuming that you didn't have a sliding scale (called VRIII now) because you didn't starve for that long? I'm asking because the VRIII is the preferred method of controlling the surgical patient’s serum glucose in the following circumstances: Patients with Type 1 diabetes undergoing surgery with a starvation period greater than 1 missed meal; Patients with Type 1 diabetes undergoing surgery who has not received background insulin; Patients with poorly controlled diabetes as defined as an HbA1c >69mmol/mol (>8.5%); Most patients with diabetes requiring emergency surgery. Obviously insulin as a high risk drug. There is no one fit for all. Would you be so kind to let me know what surgeries you had so I can understand better why you were not on a VRIII... Many thanks, Susana
 
Engineer88 said:
funnily enough this time last year I had my finger rebroken rotated and plated, which was classed as elective. I'm on an insulin pump and no one had a CLUE how to deal with me and kept insisting I should half my basal the night before and not eat anything until after my surgery at 1pm (first on the list).

Safe to say I refused to drop my basal and I stayed steady until about 11am when nerves started getting the better of me and I started dropping(a little bit not drastically), so they inserted an glucose drip and wanted me to turn off my pump. (thank god for my partner who kept me sane!)

So please, insulin pump training as well as CGM (no I'm not having finger sticks ever 15 mins! that's why I pay for CGM!)
Click to expand...

Hi
Funnily enough a couple a months ago I had a patient on a insulin pump like u. Have to admit it was the first time I've seen one. Was very concerned about that patient cause if anything was about to happen and he wasn't able to manage that pump, we would be in trouble. I kindly informed my patient I was not familiar with that equipment. I asked him to show me how he used it and what to do in case he couldn't manage it himself. I then informed my superiors that we urgently needed that training! Patient was very understanding and supportive! I felt really bad as I should be competent to deal with it. Everyday is a learning day :)
 
DavidGrahamJones said:
It was when I had a laparotomy (NHS) for what turned out to be a burst appendix and peritonitis, only seven weeks after presenting to my GP saying "I think I've got appendicitis". My whinge is about the system, not the doctor who had to refer me to a consultant (10 days), who sent me for a scan (10 days) and then I waited for the results (2 weeks) and then asked to go for surgery (2 weeks). Just as well my GP thought I had gall stones which were infected (high temperature and feeling like ****) because her antibiotics may very well have saved my life.

Sorry I digress, I need getting whinges off my chest recently, good therapy. I was given insulin while being operated on so I have no recollection of what was going on. I wasn't given insulin after coming round to my knowledge but my wife did say I had lots of tubes from different places, so I really don't know. I seemed to be OK when I had the two knee replacements (BMI), possibly because I wasn't ill. Hope that helps.
Click to expand...

I'm sure that one of those tubes was certainly for a VRIII when you had the laparotomy. But fair enough not to remember, you had a rough time. Thanks again for your testimony :)
 
Do you all have a Diabetic Passport? Cause I've seen a lot of patients with Diabetes... never saw that Passport! I came across this when I was revising some literature and I've asked for some cause I believe they can improve significantly our practice and mainly patient safety.
 
Educator123 said:
Do you all have a Diabetic Passport? Cause I've seen a lot of patients with Diabetes... never saw that Passport! I came across this when I was revising some literature and I've asked for some cause I believe they can improve significantly our practice and mainly patient safety.
Click to expand...
What do other life threatening patients have? Treatment plan? Which they travel with.
When pregnant and on insulin I travel around country with my notes in my bag, just in case.
 
From a personal perspective, my only surgical experience, post-diagnosis was about 18 months ago, planned as a day case. It went OK, although the staff on the ward had no idea how to deal with T2, never mind someone who "used to be T2", so I was something of a curiosity to them.

I was asked if they should be doing anything for me, which thankfully I could answer there was nothing. I wasn't awfully confident about what would have happened if my requirements had been complex.

My post-op, pre-homebound snack was a flaccid sandwich on white bread, which was the least appetising thing I had encountered in an age (processed cheese). To be honest, I just ate it, as I saw it as my fast-track passport to getting home.

I'm currently involved at my regional NIHR centre, which is about lead up a national study into bringing better post-surgery outcomes for diabetes undergoing elective surgery; specifically cardiac procedures and joint replacements. It will cover the 2-3 months pre-operatively, plus a minimum of 3 months post-op. It'll be interesting to see what comes out of that.
 
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