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Anyone any experience with pumps and going into hospital?

K8tie_x

Well-Known Member
Messages
199
Type of diabetes
Type 1
Treatment type
Insulin
I don't really know who to ask regarding this so I was wondering if any if you helpful bunch have any knowledge it experience with your pump and going into hospital.
Not sure if there's general policies regarding pump users or if it varies between hospitals? I'm going in on a planned overnight stay and don't want to go on the drip and stop controlling myself. My experiences in the hospital have been terrible in terms of diabetes care on normal wards but I've never been on a pump previously when I've been in hospital so don't really know where I stand.

Basically I'm going in for a course of steroids which can supposedly really mess your blood sugars up so they are going to discuss the drip with me on Wednesday. I really don't want to go on the drip if would be like starting again from scratch for me. Also being pregnant its extremely dangerous for me as well as baby. Dobt want to go into detail but heard other diabetic mums bad experiences of going extremely high and had a similar experience on the drip previously where i was in the 30s!! I would much rather use a temporary basal rate and be able to change dosages and keep monitoring it myself. I know that if I leave it to them ill end up going in overnight and being there a week as control will take so long to get back. Can I refuse to go on a drip? I'm not a very pushy person I hate feeling like I'm being a pain with the drs and nurses but I have to do what's best for me and my baby.
 
When I done my pump course the diabetes nurse said that if you go into hospital and are able to control the pump yourself you can keep it. May be different for you with you being pregnant.


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Hi

I've used a pump for 12 years and have had a few experiences of being in hospital since using one. I would push to keep your pump running and be in control unless of course there are specific reasons why your team would need to use a sliding scale. I have found a sliding scale always seems a bit of a backwards step in controlling blood sugar.

On the occasions I haven't been able to keep my pump running I have re -attached my pump as soon as I could. As long as you are confident in using temporary basal rates and giving corrections should the need arise I would think the pump will do a great job of keeping your blood sugars in range. Steroids have such an effect on blood sugar sending them high and for quite an extended period of time. Make sure your diabetes pump team know you are going into hospital and be prepared to ask for help if you are struggling to keep control especially being pregnant. Good luck I hope you are able to manage well.
 
Insist you keep your pump on and use it to it's full advantage.
I had an emergency admission about 5 years ago where I needed 500mg of steroids over a 24 hour period (IV) There was no issue with me keeping the pump as able to look after myself. Do make sure you take plenty of test strips though and your meter as the staff wont have time to test you when you want or need to test..
Doing this I managed a high of 9 on my meter, the consultant was most impressed
If they take the pump off and you have no insulin going through you, then basically it will mean about 4 hours for the basal to kick in as soon as you start to pump again. IV insulin goes in and out within about 5 mins I think but not sure on that.
Talk to the team and sort out a time table for the steroids starting so you can have a head start and ramp your basal up before the steroid hits home. If your pump has a limiter on it as to the max amount of basal per hour or over a 24 hour period, I would suggest that you up the limit quite a bit otherwise the pump can't deliver what you will need.
Obviously this does depend a lot on the amount of steroid you will be given.
 
Thank you so much for that information, I will definitely be able to manage it myself unless any emergencies occur so I will insist on that, hoping that goes down ok with the drs. I'm not sure the dosage of steroids I will be having its to develop babies lungs as its looking like I will need to deliver baby approximately 36 weeks or possibly earlier if necessary. Not really sure what percentage more I will need then now, but I feel confident doing correction doses and wil take my ketone meter in too to double check I don't develop them. Thank you so much for your advice
 
I don't think it's correct that it will take 4 hours after restarting the pump before the insulin is in your bloodstream. It's more like 30 minutes.

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I think it is a very good idea to make a strong case and to get support from your hospital diabetes team. Hopefully they are in the same hospital. But do be mentally prepared for the possibility that they may overrule you. Just as an example, ketoacidosis is incredibly dangerous to a foetus. They will probably want to be in total control of that risk. If you were to fall asleep, or make an error in testing or dosing, or there is an infusion set failure, etc, the hospital would be liable, not you. I don't think they can stop you testing for your own peace of mind, but the hospital may insist on doing their own testing and being in control of the insulin delivery. It's frustrating because the pump is probably a better method of stabilisation of your BG than the hospital IV method. I guess if you do get to do your own testing at least you can provide an additional check and warn them if there is a problem.

But I hope your diabetes team support you and you are allowed to run the pump.

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Spiker said:
I don't think it's correct that it will take 4 hours after restarting the pump before the insulin is in your bloodstream. It's more like 30 minutes.

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Yes it takes 30 mins to start working 2 hours to ramp up and then settle into a pattern so you can be talking about 4 hours for the basal to settle, there's a distinct difference between basal and bolus delivery
 
Yes I completely understand the issues of liability but the harsh truth is if its left to them I'm a much more significant risk of DKA and harm than if its left to me. I was in hospital for meningitis in December and my own ketone testing was showing ketones, I told the doctors and nurses and they didn't batter an eyelid or even ask what I was doing to counteract them. Also they checked my blood and it was 3 and never even recognised I was hypo or came back before the next lot of obs were due, luckily I had my own hypo treatments. It's scary really but I feel lucky I know how to control my diabetes but unfortunately there are newly diagnosed patients out there who this could have been a very different story for writing all this down has made me realise I think I'm going to have to be as pushy as I can to stay on pump
 
Please don't worry, you can keep your pump and use it. Hospital protocol is always if the patient can operate the pump it stays on. There's no chance of you falling asleep either steroids make you bounce of the walls .
 
I think that's a good attitude to do whatever you can to manage the risks yourself. After all it is your baby. I would feel the same way. If they insist on taking the pump off you, maybe have some injectable insulin with you as well as hypo treatment. If you see ketones and they are not dealing with it that gives you the option to deal with it yourself. Obviously that is an extreme situation, but if it was me I would want the option. Having said that if my partner was pregnant and showing high BG and ketones and she was not surrounded by a team of people dealing with it as an emergency, I would be right up in the face of the most senior manager in the place getting that fixed.

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In my experience of hospital visits, if in doubt about how they are managing your diabetes, ask to speak to the DSN. They are usually the voice of reason and can sort out any half brained schemes some Drs come up with. With prenatal care the diabetes team are usually closely watching anyway though. Good luck with your trip. x
 
No probs with me at all. Totally my control for pump and my tablets...

Take everything with you and insist you can manage. Providing you can... They will leave you in charge of yourself.

You needto stay in normal parameters and if you do they will leave you alone, or the nurses will ask you how you do it cos they are diabetic!!!!!


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When I had a op on my heel I was basically left to sort my pump out myself. I assume that whilst under the GA they kept an eye on me but once I came round it was up to me. Unfortunately I'd had to disconnect during the procedure and was still not entirely with it when I did my first bg. Luckily my significant other arrived encouraged me to reattach the pump. If you are going to fully awake can't see any reason why you can't manage the situation yourself


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I had pump on me fully in charge for my 3 night stay last year. One particular overweight type 2 nurse was fasinated at my food choices and regime..


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I had the same experience whilst in hospital having steroids pre-babies just like you're about to do. I wasn't on a pump then so i was put onto a sliding scale through a drip and the labour ward nurses were left to monitor me but they didn't have a clue about diabetes they were just following the written protocol. for some reason my bg never increased after the steroids so on their sliding scale i kept having hypo's (every hour) and i ended up having to stay in for a week (with both pregnancies, they didn't learn from the first time) to get things back under control. I have been assured though that if i was ever to be admitted again i would be allowed to use my pump and wouldn't need the sliding scale unless i was unable to operate my pump myself. Make sure you stamp your feet and make them listen to you as you know your diabetes better than anybody else on that ward will do but i am sure that by using the pump things should work well for you, best of luck
 
Thanks everyone, really appreciate your experiences. I'm going to speak to the team on Wednesday and hopefully get a plan in place of what's going to happen. Great idea Spiker though if all else fails have my MDI kit ready as a back up, silly if me really to not have even thought about that! Fingers crossed I get somewhere with them though after a good chat, the diabetes team that look after me are amazing though so I'm hoping that we are all on the same train if thought at my appointment
 
Fig- that's my biggest worry,. This "overnight stay" turning into a week because of the sliding scale. I'm not one for stamping my feet but unfortunately I think I'm going to have to if I don't get the reaction I want on Weds. I never had steroids with my first but they're concerned delivery may need to happen before 36/37 weeks this time due to the results of growth scans I've been having, feeling nervous now but I'm back weekly for monitoring and taking it week by week as to what is going to happen (32+4 now)
 
The sliding scale really is a rubbish way to manage blood sugar. It was probably state of the art - in about 1950. :-(

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i am sure you will be fine, just make sure you question everything because i found that my diabetes team, who as you say are great, were nowhere to be seen in the delivery suite which is where i went for my steroids so they were just using protocols which didn't work for me. I stamped my feet big time and insisted my diabetes consultant be called, he discharged me telling them i could treat myself better at home! He arrived as i was having another hypo and them telling me i didn't need to eat which i think was what caused him to make his decision lol. Honestly, you will be fine as long as you stay in control and i didn't have a pump then which is why it was hard for me but you are in a much better position to do all you're adjustments yourself. As i said i have been told that pump users get to take control on their insulin as its understood that its a better way to stay in control than a sliding scale now. I hope you get on ok and your baby stays put for as long as possible, i got to 35+5 and 36 weeks with mine but had steroids weeks before with both of them and everything was fine, neither had any lung problems x
 
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