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Admitted to hospital with Cellulitis/sepsis. They are very keen to use sliding scale - why?

M

MrsKitty

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So, here I am having been admitted earlier today with cellulitis in my leg, suspected sepsis, high temp and excruciating headache.

Temp has dropped, headache improved somewhat.

My sugars have been high despite not eating for 3 days with a virus but I've been following sick days rules and managing to stay in the low teens at least, if not better... So WHY are they so keen to get me on a sliding scale? Everything I've read suggests it's far from ideal. I'm conscious, capable and happy to maintain control of my own insulin (which the nurse seemed horrified by!) but in 2 hours it was mentioned 3 times and I was told they'd probably do it in the morning once the doctor sees me again. Presumably I can refuse to hand over my diabetes control - I'm here for painkillers and IV antibiotics, not a rollercoaster of insulin highs and lows!
 
Hi, I don't think they can force you to hand over diabetes control and be forced to be on a sliding scale, someone will correct me if I am wrong, when I was in hospital at the beginning of the year i was allowed to keep control myself and carry on with my insulin pump but every hospital is different, did you question them about it?


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If you have capacity (ie you're conscious and you understand the risks/benefits, which obviously you are/do) you have to consent to treatment before they can give it - of course you can refuse it.

I can understand why the nurses seem keen to stick you on sliding scale - if they aren't DSNs someone managing what is quite a complex regime themselves will freak them out - basal bolus and sick day rule are pretty complex and if they aren't used to it they will want to follow the tick box approach and stick you on sliding scale, keeping you numbers in low teens while you have a pretty severe infection is good, but I'm not sure it's successful, they will be aiming for under 8 I would think. It would be brilliant if you can get reveiwed by the DSN in the hospital (if there is one?) and if I were you I would be asking - before making a decision on how well you were doing with the sick day rules yourself - if I had ketones & stayed in double figures I would be tempted to hand over if I was confident there was DSN support & I felt rough myself, because it's a pretty intense regime of hourly testing and big corrections & I really don't think I would be confident to do it myself (it's really impressive you are, but I hope you can get get support from the DSN to consider). Having said all that, hospitals are notoriously rubbish with mangaging type 1 for inpatients - so if you would just rather do it yourself, you might very well be much better off doing that - absolutely ask them questions and ask for DSN support.

I hope you get the required support are feeling a lot better soon.
 
Hi @MrsKitty,

Perhaps the hospital think they can control your bg levels better using a sliding scale as you say your bg is still in the teens, I was once on a sliding scale for an operation several years ago and it kept my bg incredibly tight, don't forget with high bg levels the recovery time will take longer so it's worth considering the sliding scale option.

Good luck and hope your back home soon.
 
Yes, I'm another one that has never had a problem with the sliding scale. And it allows you to just lie back, relax and get better. If you have an infection, all that extra sugar you've got in your blood right now is feeding it.


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Hi all. Thanks for responses... I got the impression that it was because I was doing high corrections that they were unhappy and wanted me to rein it in a bit! Anyway, I'd got down to 7.5 by around 3am and stayed there until breakfast when a slice of toast (the first bit of food I've eaten since Thursday morning!) Sent me a bit screwy so trying to get back to single digits again!
Lunch has been another ridiculously carb laden option (even the soup tasted 'carby'!) so i've skipped it.
No DSN support over the weekend and to be honest I just didn't have confidence in the way it was discussed last night with the nurse on duty.
I will give it some more consideration though.
 
Oh and also - my original post should be read as "I've managed to keep them to a couple of readings in the low teens - the rest were better!
 
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