Insulin usage in hospital when not eating?

[ElizabethPurkiss]

Earlier last month I was taken into hospital via the out of hours doctor. Diagnosed with diverticulitis I was kept in for 2 nights, with iv antibiotics and liquid, initially nil by mouth but then allowed clear fluids.

I am type 2 but insulin dependent as well as on metformin and a new one called Empagliflozin (basically stops you absorbing sugar so you pee out sugar - you can have a high urine sugar reading but your blood sugar is low).

Whilst I was in, the nurses dishing out the medicines would not allow me to have insulin or any of my diabetic meds - because I wasn't eating!

I felt that was wrong - I was under the impression that my body needs insulin and maybe it should be controlled with a glucose drip if I started getting low.

Then I started being sick - one of the things with this new drug is that it can give you high ketones because you are peeing out sugar, I think it is, but your blood sugar level is low. The diabetic nurse who put me on it said to make sure that if ever I was ill to make sure I told the drs about this drug.

They started looking at doing an operation because the sickness must be caused by a bowel blockage! It wasn't and I explained this to them - they were very sceptical, still wouldn't let me have any diabetic meds or insulin, but at least held off on the operation!

I wasn't too sure what to do. I told them to contact the diabetic nurses, to talk with them - and to be honest if I had been feeling worse then I seriously would have worried about my overall health. Fortunately my husband was very on the ball and aware and I had very good fellow patients who kept an eye on me too!

I feel that there should be a national protocol that if a diabetic person is admitted to hospital (whatever type they are) then a properly trained diabetic nurse should be consulted with regard to the diabetic aspect of their illness. It seems that the general training that nurses/drs etc. undergo falls far wide of the mark.

Many years ago when I was nursing - if an unstable diabetic came in and weren't eating etc. then control was brought into place by use of insulin and a glucose drip. Probably that has changed as it was many years ago - but I know certainly if some of my diabetic friends had been admitted and refused their insulin then it could seriously compromise their health.

Are there any views on this - or am I totally wrong? Is it a case of not eating - don't need insulin?

 

[noblehead]

Can only speak from personal experience but the last couple of times I've been in hospital I kept my own insulin and administered it myself and also did my own bg checks, all the nurses wanted to know was the dosages I had taken and what the bg readings were like, they would record this on the notes at the end of the bed.

But yes, if your using a basal insulin then you still need to take this even if you don't eat.

 

[Daibell]

Hi. I have always insisted that I keep my meds and administer them whilst telling the staff what I'm doing and letting them test at will. I've not had a problem. Next time I would insist that you keep your meds and discuss what you take with the staff but not to let them overrule you.

 

[vic hill]

look on the NHS SITE
and get confirmed one way or another by your doc may help when this happens again
vic




Edited by a moderator to remove incorrect statement that may cause confusion

 

[Robbity]

Maybe you should get a covering letter from your diabetic team informiong the hospital of your requirements regarding your insulin and diabetic medication regime to give you some extra, official, backup too if you end up in hospital again?

Robbity

 

[donnellysdogs]

I too have been in hospital recently as a T1 (back on MDI) and had a dreadful time....

I have now lodged a complaint with PALS and a letter has gone straight to the CEO and given to him by hand...

The understanding of insulin dependent diabetics is absolutely awful. I had a surgeon that I work for tell me to take my care in hospital up directly with the CEO.. On a point that the staff need to be educated.

I ended up hypo... After begging staff for glucose and being walked down to theatre.. Last thing I remember us swearing at my surgeon that he was going to kill me on the table and tellung them to do another test (under 2.0 according to anaethetist) then Thats all I remember.. I had begged the staff for glucose.

They had put me on sliding scale that I shouldn't gave been on as I had been allowed to give my normal insulin.. And the op was only an hour..instead of giving me glucose they upped my insulin. I stumbled and could barely walk to the theatre. I had begged them not to give more insulin....and I needed glucose.

Reverse situation to you but the staff need education ref insulin....

 

[anna29]

Hospitals could possibly vary on their patient care rules ?

Mine asked me if I wanted to 'self' administer my
own insulin .
I chose to - so kept my basal Levemir going myself .

I do have and use my own hospital passport .
A diabetes hospital passport .
I kept this by my own bedside for ALL HCP's to access and read .
All foods, meds ,plus my likes and dislikes in .
Signs of my own hypers and hypo's .
Med times and routines .

I can also keep my own BG testing kit with me .
But they used their own BG kit and used these readings to put
in my patient care plan .
A tad daft as they did vary to my own Aviva expert meter/kit .
But they insisted to only use the hospital meter readings only .
It was more brutal a lancet gun - leaving me with bruised fingertips every time .
No dial on it to turn the lancet gun speed down either .

Could patient diabetes care - vary for different areas ?

 

[azure]

That sounds dreadful, DD. Did they not do a test when you were asking for glucose? : o

When I was in hospital recently, I kept my pump on and controlled my own insulin. The nurses wanted to know my BS when I was in Delivery but they only asked occasionally once I was on the ward. I was also visited by my lovely DSN to check all,was ok.

It seems people's experience can vary though as I spoke to a guy who was Type 1 and had been in the same hospital, and he was given far too much insulin to correct a high, he told me, leading to a hypo. He'd tried to tell them that the dose was too high for him.

I'm always very wary when I go into,hospital. It does seem knowledge about diabetes varies from person to,person.

 

[Daibell]

A sad story. My advice to anyone with rare exceptions is to refuse to have all this sliding scale nonsense. Whats' the point and with nurses not having a clue it's an accident waiting happen. If you know what you are doing with your insulin and measure frequently which the staff should also do I have no idea where sliding scale comes in. For an op a few years back the nurse tested me an hour or so before the op, saw my sugar was a bit low and put me on a glucose drip until my sugar came back up. Sensible and no need for sliding scale kit.

 

[DiabeticCat]

I believe that it varies very much between the nurses who are on the ward and how much they are educated plus what hospital your in. When i was originally diagnosed i ended up in hospital that same night as i left going to the doctors far too long (my own fault, i was being stubborn/thought i only had a bug took being ill for 2 months and extreme weight loss/an episode in supermarket) for me to go the doctors.

But the nurses on the 1st ward i was on were very knowledgeable and i was seen by a diabetic nurse aswell and my BS were constantly checked .ect because i was a VERY new diabetic but on the 2nd ward whilst they still seemed to know a fair bit i got the feeling that they didn't 'know' as much as the 1st nurses i was seen/monitored by and i was pretty much left to handle myself/my injections on the last day i was in (Only my 2nd day knowing i was diabetic/being told and shown how to do injections).

But as others have said it's best to constantly keep it on you, especially when in hospital & to not let the nurses take it off you/tell you what to do in regards to your medication. And also in terms of the risk of having hypos in hospital you could always keep one/two packets of glucose tabs or liquid in with your medication in case of hypo's x

 

[donnellysdogs]

Hospitals could possibly vary on their patient care rules ?

Mine asked me if I wanted to 'self' administer my
own insulin .
I chose to - so kept my basal Levemir going myself .

I do have and use my own hospital passport .
A diabetes hospital passport .
I kept this by my own bedside for ALL HCP's to access and read .
All foods, meds ,plus my likes and dislikes in .
Signs of my own hypers and hypo's .
Med times and routines .

I can also keep my own BG testing kit with me .
But they used their own BG kit and used these readings to put
in my patient care plan .
A tad daft as they did vary to my own Aviva expert meter/kit .
But they insisted to only use the hospital meter readings only .
It was more brutal a lancet gun - leaving me with bruised fingertips every time .
No dial on it to turn the lancet gun speed down either .

Could patient diabetes care - vary for different areas ?

I too have a passport! Still had worst care I have experienced in 30 years of various ops without the "passport".

 

[donnellysdogs]

I think it also depends on whether you are being taken in as a planned op or in an emergency.. In all cases with me my hospital have been atrocious. On emergency they wrote down I was a type 2....
Planned... They didn't have a clue. Separate hospital to my diabetes hospital...

 

[CarbsRok]

I think it also depends on whether you are being taken in as a planned op or in an emergency.. In all cases with me my hospital have been atrocious. On emergency they wrote down I was a type 2....
Planned... They didn't have a clue. Separate hospital to my diabetes hospital...

DD you must remember only children have type 1 diabetes so being an adult obviously your were type 2 . I did have this conversation in out patients a couple of years ago regarding my diabetes status. I ended up asking the nurse what she thought happened to the children who had type 1.

 

[ElizabethPurkiss]

I can't believe all these responses! I thought it was only our hospital that was atrocious!

I did have my insulin with me, but because there were not doing anything about the possibility of a hypo I let them tell me not to have it - had they been more knowledgeable and helpful it would have been my insulin I would have had! And I agree about the hospital meters - the lancets were brutal and the nurse kept going for the same bit! I asked if I could at least use my own lancets even if not the meter - but no that wouldn't do either!

It does concern me that there is this lack of knowledge. I will certainly be taking this up. My son is an HCA at the hospital in the children's outpatients and he got his pump by going directly through the CEO. Maybe the two of us will follow it through more - except that CEO has gone and I'm not sure another one has been appointed yet or not! It would be 'easy' (in a way) to employ an extra diabetic specialist nurse who could be called by the wards each time a diabetic patient was admitted and for the drs to liaise with the diabetic team.

When my ds was about 12 his appendix was beginning to play up - saw a great surgeon who felt that whilst his appendix was really urgent, because it eventually would be, whilst his diabetes was reasonably under control it would be better to take it out there and then, rather than wait for it to become an emergency and probably find the diabetes would be less controlled and that would cause more problems. Now it seems that they are even less knowledgeable than they were back then, when they should be more knowledgeable because the whole diabetes thing is evolving so much with more and more people having it and new insulins etc.

 

[donnellysdogs]

DD you must remember only children have type 1 diabetes so being an adult obviously your were type 2 . I did have this conversation in out patients a couple of years ago regarding my diabetes status. I ended up asking the nurse what she thought happened to the children who had type 1.

Trouble is- now being in young 50's they automatically assume T2... Not professional.
They forget that we were children!!-lol