Diabetes and the Hospital

[SueNSW]

Do you all have a Diabetic Passport? Cause I've seen a lot of patients with Diabetes... never saw that Passport! I came across this when I was revising some literature and I've asked for some cause I believe they can improve significantly our practice and mainly patient safety.

Can I ask what a Diabetic Passport is??

I'm in Australia, so can't meaningfully add to your research - though I am due to have a bilateral TKR on 4th April in a private hospital here, so will be interested to see how my T2 (on insulin) is handled

 

[noblehead]

I'm particularly interested in knowing your experiences when u were hospitalised for an elective surgery... pre-assessment phase, peri-operative phase and discharge phase! How did you manage your diabetes? Were u the first on the surgery list? How was it managed by nurses and doctors? Did you feel comfortable with the management you received? What would you like to see changed? Was it an overall good or bad experience?

On the last two occasions I just managed my diabetes myself, took along my own insulin pens (I'm a type 1) and bg testing kit, the nurses were fine with this and all they wanted to know was what insulin doses I'd taken and what my bg levels were, this was all recorded in my notes. 25 years ago when I was admitted as an inpatient I wasn't allowed access to my own insulin or bg kit and it was all locked away in a drawer, so times have moved on for the better in that respect.

Usually if your insulin dependant they'll have you down as first on the list for surgery, the management I received was good and can't complain and the food on offer wasn't a problem either, overall a good experience from a type 1 perspective compared to previous times.

 

[Engineer88]

Do you all have a Diabetic Passport? Cause I've seen a lot of patients with Diabetes... never saw that Passport! I came across this when I was revising some literature and I've asked for some cause I believe they can improve significantly our practice and mainly patient safety.

No, I don't carry a diabetic passport, all the information you could need is on the health app on my phone and available through the emergency ID. I also don't wear medical ID anymore but I do wear an insulin pump.

 

[Educator123]

What do other life threatening patients have? Treatment plan? Which they travel with.
When pregnant and on insulin I travel around country with my notes in my bag, just in case.

Hi
Well some life threatening conditions carry a bracelet or a card isn't it? I find the diabetic passport a real life saving tool if used! Like I said I still haven't seen one. I tried to ask for some for my hospital but nobody go back to me unfortunately As for your condition I do believe you do the right thing: it's always better to keep everything with you in case an unfortunate situation happens. People need to understand your condition in order to help u in an emergency situation! Take care

 

[Educator123]

From a personal perspective, my only surgical experience, post-diagnosis was about 18 months ago, planned as a day case. It went OK, although the staff on the ward had no idea how to deal with T2, never mind someone who "used to be T2", so I was something of a curiosity to them.

I was asked if they should be doing anything for me, which thankfully I could answer there was nothing. I wasn't awfully confident about what would have happened if my requirements had been complex.

My post-op, pre-homebound snack was a flaccid sandwich on white bread, which was the least appetising thing I had encountered in an age (processed cheese). To be honest, I just ate it, as I saw it as my fast-track passport to getting home.

I'm currently involved at my regional NIHR centre, which is about lead up a national study into bringing better post-surgery outcomes for diabetes undergoing elective surgery; specifically cardiac procedures and joint replacements. It will cover the 2-3 months pre-operatively, plus a minimum of 3 months post-op. It'll be interesting to see what comes out of that.

Hello
Well, from what I've been reading, most of the experiences described in here are very similar... which I don't think it's necessarily good! A lot of people mentioned "they didn't know much about my diabetes condition" and that's really upsetting and worrying. So it's really an issue that needs to be addressed. The same goes for the menus for the post operative diabetic patients. As for your involvement in the NIHR Centre, can I ask you to keep me on the loop regarding that study? I'm very curious to know the results as well! Many thanks for your response

 

[Educator123]

No, I don't carry a diabetic passport, all the information you could need is on the health app on my phone and available through the emergency ID. I also don't wear medical ID anymore but I do wear an insulin pump.

Hi

Can I ask if you ever needed to use it? That is, in a emergency situation, if you had one, did someone looked into your phone to look for that information? Who told them it was in your phone? You? Were u well enough to tell them? As for for insulin pump, do you think the majority of the healthcare professionals know how to use it? Did you ever had a situation where u weren't self caring with it? If yes, what happened? Thanks

 

[Educator123]

On the last two occasions I just managed my diabetes myself, took along my own insulin pens (I'm a type 1) and bg testing kit, the nurses were fine with this and all they wanted to know was what insulin doses I'd taken and what my bg levels were, this was all recorded in my notes. 25 years ago when I was admitted as an inpatient I wasn't allowed access to my own insulin or bg kit and it was all locked away in a drawer, so times have moved on for the better in that respect.

Usually if your insulin dependant they'll have you down as first on the list for surgery, the management I received was good and can't complain and the food on offer wasn't a problem either, overall a good experience from a type 1 perspective compared to previous times.

Hi

Things have changed for the better hopefully. Glad to hear you had good experiences with your diabetes while you where in hospital. Normally hospitals do tend to prioritise diabetics on theirs lists but sometimes thats doesn't happen. What the new guidelines regarding elective surgery say is that you need to be prioritised on the list and then there are several scenarios for different diabetics (Type 1, Type 2, Type 2 on insulin) depending on the number of meals they foresee the patients are gonna skip... There are also new fluids on the market (still very expensive) for VRIII to minimise NA and K losses and to keep a diabetic patient the most stable as we can... Obviously, all of this will work out fine if during pre-assessment the patient is completely involved and he/she understands the possible scenarios that may or not happen. They should also be advised on what to do with their regular medication (there are new guidelines for this as well) but as we know, every one is different so this needs to be managed case by case. At the end of the day, the patient will be, always, the manager of his own condition, as long he's/she's able to

 

[Resurgam]

I have only been diagnosed for a few months but suspect that I have been sensitive to carbs and not able to manage them well for a very long time - but I 'found' low carb eating back in the 70s. I have only been in hospital for the birth of my two babies, but eating low carb was not easy and I was reprimanded for leaving of much of the food ordered, but so much of it was unsuitably high carb. Most health professionals I have met have been absolutely against doing Atkins and I have been put on so many diets which have made me feel so ill and put on weight so fast - all my fault too, I was told in no uncertain terms. I have a great incentive to ensure that I remain healthy and alert as long as possible, as if I were put into a care home and fed on bread and potatoes my days would be numbered.
The needs of a diet controlled type 2 are very different from a type 1 - not so urgent, perhaps, but a few days accumulating glucose in the blood must slow down healing, and also make a person feel rather dismal and depressed.

 

[Educator123]

Can I ask what a Diabetic Passport is??

I'm in Australia, so can't meaningfully add to your research - though I am due to have a bilateral TKR on 4th April in a private hospital here, so will be interested to see how my T2 (on insulin) is handled

Hello hope you're doing well on the other side of the world

So a person with diabetes on insulin can choose to carry a credit-card sided paper record called the Insulin Passport. It can be used to record up-to-date details of the type of insulin, syringes and pens that you use,
 emergency information that tells people what to do if you are found ill or unconscious and other information to help in an emergency, including contact names and telephone numbers and other medication that you could be taking. I don't know the reality in Australia but I would try to understand in pre-assessment how everything is going to happen. They need to assess the adequacy of your glycaemic control. The risks of proceeding when control is suboptimal should be balanced against the urgency of the procedure. They also need to identify other co-morbidities and, if they exist, refer you to the appropriate team for optimisation. Then, your inpatient admission plan should include: timing of admission, location, timing of surgery, pre-admission management of medications, availability of usual insulin (you may need to take your own if non formulary). They also need to ensure that you're fully consulted and engaged in the proposed plan of management. You should be given written instructions with the changes they need to make to your medication prior to admission. They should plan the duration of your stay and make preliminary discharge arrangements and finally, they should consider the need for home support following discharge and involve the primary care team in the discharge planning.

This is currently what the National Authorities in the UK want to see in place. Basically my advise would be, ask all the questions that came to your mind. Being in a hospital for a procedure or when you are acutely ill can be tricky for diabetics. On the one hand, the stress of the acute illness tends to raise blood glucose concentrations. On the other hand, the anorexia that often accompanies illness or the need for fasting before a procedure tends to do the opposite. Because the net effect of these countervailing forces is not easily predictable in a given patient, the target blood glucose concentration is usually higher than when the patient is stable.

Hope this helps Wish you a speed recovery! And please let me know the outcome of your experience in the hospital ok?
Thank you so much

 

[Educator123]

I have only been diagnosed for a few months but suspect that I have been sensitive to carbs and not able to manage them well for a very long time - but I 'found' low carb eating back in the 70s. I have only been in hospital for the birth of my two babies, but eating low carb was not easy and I was reprimanded for leaving of much of the food ordered, but so much of it was unsuitably high carb. Most health professionals I have met have been absolutely against doing Atkins and I have been put on so many diets which have made me feel so ill and put on weight so fast - all my fault too, I was told in no uncertain terms. I have a great incentive to ensure that I remain healthy and alert as long as possible, as if I were put into a care home and fed on bread and potatoes my days would be numbered.
The needs of a diet controlled type 2 are very different from a type 1 - not so urgent, perhaps, but a few days accumulating glucose in the blood must slow down healing, and also make a person feel rather dismal and depressed.

Hi How are u?

U seem to be a bit discouraged with your condition and not being able to deal with it the best way possible. I'm really sorry to hear you say that. I believe that being a diabetic type 2 controlled by diet it's not an easy task. Can I ask u your latest HBA1c level? How many times do you control your blood sugar? Are you seen/followed by any specialist diabetic team? Do you have any other co-morbilities associated to the diabetes (you mentioned slow healing)? Please let me know so I can understand a bit better your condition! I'll wait for your reply

 

[Resurgam]

Hi How are u?

U seem to be a bit discouraged with your condition and not being able to deal with it the best way possible. I'm really sorry to hear you say that. I believe that being a diabetic type 2 controlled by diet it's not an easy task. Can I ask u your latest HBA1c level? How many times do you control your blood sugar? Are you seen/followed by any specialist diabetic team? Do you have any other co-morbilities associated to the diabetes (you mentioned slow healing)? Please let me know so I can understand a bit better your condition! I'll wait for your reply

I have a deep seated sorrow from many years ago. My grandmother died from the complications of diabetes when I was 6 years old, she had a series of operations as she developed gangrene in her feet and legs. I spent a long time with her.
I have done very well in controlling my blood glucose levels - just wish that I'd not been put on statin and Metformin straight away as I reacted badly to both of them. I've done low carb for a very long time, but over and over again been told how bad it is, yet it has always been bad for me when I stopped.
I have a failed thyroid and take thyroxine - when I remember - memory is shot now, otherwise I'm not bad for my age. I have not seen my doctor since diagnosis - my file is marked no further action. I had three education meetings with people sent out by Poole hospital to do meetings in a local library - eat carbs they told us, healthy carbs.
I seem to have no symptoms of anything much being wrong - see my signature for the fairly normal blood test results after just 80 days on strict low carb - healing is normal, I just dread losing my independence and being put on tablets which destroy my intellect and memory, and a diet which makes me feel ill.

 

[SueNSW]

@Educator123 - thanks for the Passport info - not sure there is something similar here - but as per my signature, I've only been diagnosed since November.

Fortunately my control seems to have stabilised very effectively - everyone seems happy with figures. I have been told my surgery will probably be first on the list, so to take normal medication night before - then as I won't be eating that morning, not to inject before I head in. If that changes, obviously I'll query things.

I'm expecting to be in for up to two weeks including rehab and certainly hope that as soon as I'm compos mentis they'll let me handle my own injections/meds/testing and that there won't be any need for adjustments.

The hospital advertises they have wifi so hopefully I'll be able to keep in touch with the forum and ask any necessary questions if they come up . Thanks for the good wishes

 

[Educator123]

@Educator123 - thanks for the Passport info - not sure there is something similar here - but as per my signature, I've only been diagnosed since November.

Fortunately my control seems to have stabilised very effectively - everyone seems happy with figures. I have been told my surgery will probably be first on the list, so to take normal medication night before - then as I won't be eating that morning, not to inject before I head in. If that changes, obviously I'll query things.

I'm expecting to be in for up to two weeks including rehab and certainly hope that as soon as I'm compos mentis they'll let me handle my own injections/meds/testing and that there won't be any need for adjustments.

The hospital advertises they have wifi so hopefully I'll be able to keep in touch with the forum and ask any necessary questions if they come up . Thanks for the good wishes

Hi
Sorry for the late reply... from what I can understand you seem to have your diabetes under control! Like I say each person is different but to be fair I've never seen anyone on metformin 2g per day all at night plus the insulin. And apparently you never experience any hypos??? There is a lot changing with these new guidelines in the UK! I'm looking forward to see if the majority of the hospitals is going to follow them and how the patients - the most important part in the equation - are going to feel/react/adjust Would love to know how everything happened after your surgery Take care x

 

[Educator123]

I have a deep seated sorrow from many years ago. My grandmother died from the complications of diabetes when I was 6 years old, she had a series of operations as she developed gangrene in her feet and legs. I spent a long time with her.
I have done very well in controlling my blood glucose levels - just wish that I'd not been put on statin and Metformin straight away as I reacted badly to both of them. I've done low carb for a very long time, but over and over again been told how bad it is, yet it has always been bad for me when I stopped.
I have a failed thyroid and take thyroxine - when I remember - memory is shot now, otherwise I'm not bad for my age. I have not seen my doctor since diagnosis - my file is marked no further action. I had three education meetings with people sent out by Poole hospital to do meetings in a local library - eat carbs they told us, healthy carbs.
I seem to have no symptoms of anything much being wrong - see my signature for the fairly normal blood test results after just 80 days on strict low carb - healing is normal, I just dread losing my independence and being put on tablets which destroy my intellect and memory, and a diet which makes me feel ill.

Hi again

So sorry to know that If I was you, and forgive me for saying this, and if you're not happy with your current status, I'd look for other opinions/solutions. What works for one, might not work for the other! Please don't loose your hope. Files should be marked with a a "no further action" when the patient is well controlled and happy with the situation. If that's not the case, make them "open" your file again!

 

[Resurgam]

Oh - I just wait. The clinic has a fairly constant turnover of doctors, and I don't see the same one very often. I will get a blood test for my thyroxine levels each February, so I can ask for a full set including Hba1c then if I don't get any notification before then. I am actually fairly relieved that I am not being harassed about my doing Atkins - in the past it has seemed that it is close to Devil worship or Druidic practices as described by the Romans. As the only one in the education session who had improved readings I feel that I am well out of the system.

 

[Educator123]

Oh - I just wait. The clinic has a fairly constant turnover of doctors, and I don't see the same one very often. I will get a blood test for my thyroxine levels each February, so I can ask for a full set including Hba1c then if I don't get any notification before then. I am actually fairly relieved that I am not being harassed about my doing Atkins - in the past it has seemed that it is close to Devil worship or Druidic practices as described by the Romans. As the only one in the education session who had improved readings I feel that I am well out of the system.

I do believe one of the problems in here is exactly not be able to see the same doctor! Where's the part of "continuity of care? The GP in my country knows me for than 20 years! Can I ask you to let me know those results? Im quite curious to know what your HBA1c is now...

 

[Resurgam]

I do believe one of the problems in here is exactly not be able to see the same doctor! Where's the part of "continuity of care? The GP in my country knows me for than 20 years! Can I ask you to let me know those results? Im quite curious to know what your HBA1c is now...

I have only had two tests for Hba1c - they are in my signature, but the first one was done when I was expecting to have my Thyroxine test at the beginning of November. The doctor told me I was diabetic over a week after he'd had the results and asked me to go to see him as a matter of routine - no urgency. The second was 80 days later. The numbers were 91 to 47 - I am not sure what the units are for Hba1c.

 

[SueNSW]

Hi
Sorry for the late reply... from what I can understand you seem to have your diabetes under control! Like I say each person is different but to be fair I've never seen anyone on metformin 2g per day all at night plus the insulin. And apparently you never experience any hypos??? There is a lot changing with these new guidelines in the UK! I'm looking forward to see if the majority of the hospitals is going to follow them and how the patients - the most important part in the equation - are going to feel/react/adjust Would love to know how everything happened after your surgery Take care x

I guess with my dosage - I just like to be different - but it certainly seems to be working for me (touch wood!!) Certainly never had a hypo (so far) - looking back through my record, lowest I went down to was 3.9 one morning in January after a 40 minute bike ride - but no hypo "feelings"

I find some of the "guidelines" in the UK a bit odd - especially the NICE suggestion of an "ideal" range starting at 4.0 - while DVLA wants a minimum of 5.0 for driving . I'm sure there are anomalies in the advice here too of course

Good luck in what you are trying to promote - and will certainly come back and report in when I can

 

[Educator123]

I have only had two tests for Hba1c - they are in my signature, but the first one was done when I was expecting to have my Thyroxine test at the beginning of November. The doctor told me I was diabetic over a week after he'd had the results and asked me to go to see him as a matter of routine - no urgency. The second was 80 days later. The numbers were 91 to 47 - I am not sure what the units are for Hba1c.

Morning
Glycosylated haemoglobin may be measured 6-12 monthly. In patients with stable type 2 diabetes an annual test may be sufficient while in those with poorly controlled diabetes, more frequent testing may be needed. It is rarely helpful to measure HBA1c more frequently than 3 monthly. The World Health Organisation (WHO) suggests the following diagnostic guidelines for diabetes:

• HbA1c below 42 mmol/mol (6.0%): Non-diabetic
• HbA1c between 42 and 47 mmol/mol (6.0–6.4%): Impaired glucose regulation (IGR) or Prediabetes
• HbA1c of 48 mmol/mol (6.5%) or over: Type 2 diabetes

You said you were taking any medication, only controlling your diabetes with diet... I would definitely repeat those bloods tests and take it from there

 

[satindoll]

I broke my hip last September, the following day I had it operated on under sedation and a spinal tap, the hospital were very happy for me to do my own tests and injections, the food was a mixed bag but I was able to find a lot of low carb dishes to suit my tastes, the only one that was difficult was breakfast as they no longer offer a cooked one, my last stay before this in 2002 they offered scrambled or boiled eggs or bacon and tomatoes, but as I was only in for 3 days this time I settled for toast and butter to take my morning jab.