Quick check - T1s in hospital

[LittleGreyCat]

Had an interesting discussion the other day about T1s (or insulin dependant T2s) BG management as an in-patient.

(1) Hospitals like to use their BG meters as they are designed to be far more accurate than consumer BG meters. They are also regularly calibrated.

(2) Hospitals like to run BG higher than normal to provide a safety net against hypos - because the damage done by multiple hypos during a stay at hospital can be far greater than the damage done by running BG at slightly higher levels.
[This may be code for the increased risk of insulin administration and meal consumption not being as well coordinated as at home, of course.]

How does this match with the experience of T1s here who have been in-patients?

Edit: I was thinking more about people admitted for non-diabetic reasons e.g. surgery, or for diabetic complications after initial diagnosis. Admission on diagnosis is probably a different issue.

Regards

LGC

 

[donnellysdogs]

Don't think many are actually admitted nowadays at diagnosis. I was 30+ years ago but in those days it was a totally different ball game with meters and testing etc and education.

 

[keishamarie]

Had an interesting discussion the other day about T1s (or insulin dependant T2s) BG management as an in-patient.

(1) Hospitals like to use their BG meters as they are designed to be far more accurate than consumer BG meters. They are also regularly calibrated.

(2) Hospitals like to run BG higher than normal to provide a safety net against hypos - because the damage done by multiple hypos during a stay at hospital can be far greater than the damage done by running BG at slightly higher levels.
[This may be code for the increased risk of insulin administration and meal consumption not being as well coordinated as at home, of course.]

How does this match with the experience of T1s here who have been in-patients?

Regards

LGC

When I was in hospital, They asked me to use my own reader because they said it was better! & When i was first diagnoised i was put onto a ward straight away and given my own new reader. So my hospital ask me to use all my own stuff and they always make sure that I get enough insulin for my reading to be 'normal' so they dont stay above any safety net

 

[SandyDee]

I've been in hospital a few times and it seems to depend on the hospital how they treat your diabetes. They will usually use their own BG meters, but are happy for you to use yours if you want to. They wont use yours.
I've always been in for operations and haven't been in since having the pump, so I've always had the sliding scale - where they put you on a glucose drip and insulin drip at the same time, only using the insulin when the sugars go high. This means that you are generally high, but this is only really up to the operation. I have a very bad reaction to anaesthesia and will tend to go very low as a result, which they've always dealt with very well, but I think they would generally run you high to avoid hypo.

 

[donnellysdogs]

Aaaah, but is the OP on abot 1st diagnosis or hospitilastion after?

In 30 years I been in a few occasions for ops and investigations and always been left to manage myself with my own injections or nowadays pump. All hospitals do with me us write down all of my results once a day and ask me what my result was pre being discharged. I'm well happy with this..

I've never been given any advice at all during hospital stays. In fact the stay lasy year had a type 2 nurse asking me about how she could improve her bloods!!....

I know my own body, I manage myself at home or in a hotel.. So why should hospital be any different?.. Those are the words I actually use when I am admitted.... So they know I can be left to manage myself..

 

[noblehead]

Once over they wouldn't let you keep your own insulin in hospital as all drugs had to be locked away, now they appear to be quite relaxed about type 1's using their own insulin and keeping it with them at all times.

I know when I was last in hospital I did had my own insulin and did my own bg tests (with my own meter), all the nurses wanted to know was what doses I'd taken and what my bg levels were, when told they recorded it in my notes, there was never any mention of running bg levels higher to avoid hypo's.

 

[LittleGreyCat]

Sorry - really asking about admission for non-diabetic stuff.
I'm mainly interested in how diabetics are managed when they go in for the same kind of stuff as non-diabetics.
However any information is good

 

[keishamarie]

Ive been in for non diabetic things as well like questionable appendicitis and again I used my own reader and my own insulin the nurses just came along and asked me what it was and then wrote it in my notes

 

[donnellysdogs]

My non diabetic ops and aruff have all been me doing my own thing but just informing nurses of results... Absolutely no involvement from hospital at all for anything...to be honest, nobody on my last stay had even seen a pump let alone try to give me advice on it !!

 

[Flowerpot]

A couple of years ago after an operation to try to save my leg I stayed on a sliding scale for 24 hours after surgery as I was too poorly to operate my pump. I was appalled by the blood sugars that were considered acceptable, anything up to 14 was deemed fine and something only to be expected after an operation! I knew I had to come off the sliding scale and take control in order to give my leg the best chance of recovery.

The ward staff insisted on using their blood glucose meters for my records but I was using mine as well to know where I was and to get some stability back.

 

[anniehi41]

After my Pancreatectomy I was on an Insulin sliding scale. Not having been diabetic before at all until the operation I knew nothing at all about how to manage Diabetes. The care in the Critical Care Unit for the five days I was there was excellent, but when I was transferred to the ordinary ward the care was disgraceful. I was on a Insulin sliding scale at first and then after about a week I was on manual injections. During the time I was in the ordinary ward I had four serious Hypos due to neglect, I realise now they were giving me far too much insulin for the small amount of food I was having. There were too few Specialised Diabetic Nurses on the wards and none after 6pm, one ward nursing Sister told me that ONE was the floor. I think there should be a separate ward for Diabetics having operations or being made Diabetic by the operation with Specialist Diabetic Nurses running them.

 

[toby64]

Hello all, i have just come out of hospital a few weeks ago, but have been in 2 different hospitals 3 times this year, and 3 times last year, if i was coming in to hospital as a emergency,they would immediately put in an IV and sometimes 2, and when i have been not well enough to manage my T1 they have used a sliding scale, but in Australia they like to use the insulin that you would use at home, not necessarily yours though. If i have had to come into hospital for ops they usually try to put you on the early list s or like my last stay they bought me in 2 days early, and usually would have gone home the day after the surgery, but i had a reaction to the knockout mix and ended up in hospital for 5 days, in the last few days i was managing my own sugars and the doctors had put self managed on my files, i used my BG meter and my pens, but nursing staff had to watch me use my meter and check all insulin given, both hospitals do work very similar here, but if you can prove you are able to manage your diabetes they seem to leave you alone and just keep checks on you.
Hope this may help
PS i have one philosophy, it is your body ask heaps of questions, and if things do not make sense to you, don't be afraid to say so, and we are all different, and very few of us are text book diabetics.
Best Regards
Toby

 

[Daibell]

Hi. For my last op this year I used my own insulin and meter when I wanted but the staff also used their own meter for testing when they felt it important. There was never any conflict. I've heard bad things about sliding scale where staff don't know what they are doing or just disappear. For many T1s I don't see the point and my last hospital said they tried to avoid sliding scale and leave it up to the patient to manage helping if needed. I don't believe hospital meters are any more accurate than consumer ones.

 

[LittleGreyCat]

Thanks for all the info so far.

Supplementary - how well did all of you and/or the hospital staff handle the transition off sliding scale?

 

[toby64]

Hello again the difficulty with both insulin infusions and sliding scales is that they have you bouncing from hypo to hypers and i always do better as soon as i am able to back control and off both of them, and a couple of days home and i am back on track.
Regards
Toby