Can someone help make sense PLEASE?

[sheil19]

I'm a type 1 diabetic who has recently got his tonsils out. I got them taken out last Friday morning. For 24 hours I had to take steroid injection to reduce swelling as it was really affect me. Since the steroid my BG levels have been high teens which I expected them to go up but have also upped all my ratios. Then today(Thursday) at 15:30 I had a massive bleed on my throat which I know can be common but this is when things have got messed up. I've been fasting since then and not been allowed take any insulin or put on a drip since the bleed at 15:30. It's now 1:00am and I'm still not allowed take insulin or a drip and I know have trace ketone and my blood sugar is 16 and rising. I take a split dose of Levemir at 8am and 9pm so I currently have no active insulin in me....does this make any sense to anyone else???


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[AlexMBrennan]

You should keep taking basal insulin even if you don't eat anything but to be honest this case sounds like something that should probably be treated at hospital (glucose and insulin IV whilst you can't eat)

 

[Spiker]

Sounds like you are in hospital? Get the diabetes team involved, hopefully you know them? The hospital may need to take control of your insulin but they should never, ever stop it. The trauma and the steroids will all be raising your blood glucose significantly. The raised blood sugar will impair healing and significantly increase the risk of infection. Insist on an explanation immediately, from a doctor not a nurse, why they are not allowing you insulin. Make sure they understand you are T1. Make sure they understand the distinction between basal insulin and quick acting (though frankly you need both, basal is the minimum). Ask them to explain how they will prevent you going into DKA, diabetic ketoacidosis, without insulin.

Hopefully it is just a misunderstanding.

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[AlexMBrennan]

Well, if he's in a hospital then why is he here on the forum asking for help rather than, I don't know, a nurse? Also, to amend my earlier post: You should consider taking fast acting insulin without food to correct high BG (trauma from surgery, combined with cortisone can easily send your BG sky-high without food, and there is no need to leave it there just because you are not eating)

 

[sheil19]

Because this is exactly what happened me last night and I was furious and upset when they TOLD me not to take any insulin....the orders from the doctor supposedly!! Blood sugars got nice and high, right up to 18. Eventually a doctor seen me at 3am and was ever so nice in telling me it was okay to take insulin!! Not very pleased as I've only had about 4 hours sleep and it's not the best for healing now or my diabetes. Blood sugar is now currently 14 so finding it hard to come down even with extra insulin.


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[Spiker]

Use a sickness protocol until you get your BG down. Test ketones. Test BG at least every 4 hours. Be prepared to up everything - basal and ratios - until you are over the steroids and the surgical trauma.

I think you did the right thing asking for advice.

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[AndyS]

Uhm... I thought rule 1 was "Don't stop taking your insulin" at least your basal.

Big question mark over the "P" in HCP in this case.
As Spiker said, ask that the diabetes team at the hospital be pulled into your treatment.

Personally I would also ask the diabetes team to have a word with the Dr that ordered you were not to take insulin.... seems like a rather bad decision to me.

 

[phil55494]

If you're in hospital, even if not your regular one, get the diabetes team out to see you. You shouldn't be told to stop all insulin unless the hosp is giving you insulin as part of the drip.

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[AndyS]

Though I think they usually stick you on insulin via a fancy machine so they can vary the dosage more easily instead of just sticking it in a standard drop bag.

Just so you have something big and obvious to look for.

Of course if in doubt, ask them what is in everything that they plug into you, people make mistakes and making them stop and think is always a good thing.

 

[phil55494]

Sliding scale that's what I'm trying to remember.

Basically a syringe pump feeding insulin into the drip port which they can then vary depending on BG levels. A must for T1 if it is a glucose bag on the drip and not allowed to manage own insulin.

I'm now having flashbacks to when I was diagnosed...

 

[AndyS]

Sliding scale that's what I'm trying to remember.

Basically a syringe pump feeding insulin into the drip port which they can then vary depending on BG levels. A must for T1 if it is a glucose bag on the drip and not allowed to manage own insulin.

I'm now having flashbacks to when I was diagnosed...

Yes I had "sliding scale" in mind but was never clear if it was the syringe pump machine or the process / system they used to work out what to give you.

Only time I was ever on it was when I was diagnosed and I caused merry hell since I got bored of being chained to the bed on the ward, wanted to go for walks. I was told it was battery backed but the silly thing only lasted 5 minutes before making a fuss so I ended up standing in the hallways to plug in.. I found it hilarious, the nurses had a fit since they could never find me

 

[Daibell]

Of course the insulin should be continued if the sugars are going to high; simples, and I can't think of any medical reason why any HCP should say otherwise. I've seen horror stories on the forum with the mis-use of sliding scale stuff, so I will always push to retain my insulin and sensible control of it. I'm having an op next week and the nurse at the pre-op said they tried to avoid using the sliding scale kit if they could and we had a sensible discussion about my insulin and I expect to retain my pens.

 

[donnellysdogs]

See when you can get back to doing your own insulin..

Am so seriously hoping as it's now Friday they have discharged you....


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[Belzedar]

Because this is exactly what happened me last night and I was furious and upset when they TOLD me not to take any insulin....the orders from the doctor supposedly!! Blood sugars got nice and high, right up to 18. Eventually a doctor seen me at 3am and was ever so nice in telling me it was okay to take insulin!! Not very pleased as I've only had about 4 hours sleep and it's not the best for healing now or my diabetes. Blood sugar is now currently 14 so finding it hard to come down even with extra insulin.

So, laddie, how are you today?

 

[phoenix]

Yes I had "sliding scale" in mind but was never clear if it was the syringe pump machine or the process / system they used to work out what to give you.

Only time I was ever on it was when I was diagnosed and I caused merry hell since I got bored of being chained to the bed on the ward, wanted to go for walks. I was told it was battery backed but the silly thing only lasted 5 minutes before making a fuss so I ended up standing in the hallways to plug in.. I found it hilarious, the nurses had a fit since they could never find me

I agree it gets used for both. When I was diagnosed here in France, they used a reactive sliding scale for the insulin and adjusted every two hours depending on glucose levels but not with one of those syringe drivers, they used an insulin pump.
(ketones were there but not very high so insulin was all that was necessary)

 

[sheil19]

Thanks for all the help guys, finally out of the hospital after a long 11 nights. Feeling a lot better now recovering at home and controlling my own diabetes management. All my ratios have increased and also my background insulin. To be honest I probably should have just gone against doctors/nurses advice and taken insulin and looked after it myself. It's all good the past few days and my BG levels are good and feeling a lot better and more positive.


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[Jaylee]

Glad yer OK Sheil19.

I have found out the hard way regarding patient care & relative liaison that these days, if you have the "notes at the foot of your bed" & some sort of basic internet access?
You can find out what the experts fail to tell you...
At least I did the night my dad died...
They only let me in on it when I called them to let them know I think he's moved on...

 

[Spiker]

Hey, great that you are out! That is a drag being in for 11 days though.