I have recently made a very strong complaint about the poor and dangerous care of type 1 diabetes in our local hospital. I spoke to the complaints people at the hospital and the lady was very good and actually wrote her report, which she has sent to me for approval, very accurately. That in itself is unusual. The particular incident was a couple of years ago but was one of many in the same circumstances.
The incident was one of being on a sliding scale of insulin/glucose for the fasting night pre-op. Every time I have been on one, the scale has been set wrong for my own needs and I have been allowed to go hypo. The hospital has a policy that a BG of 3.7 is the point at which glucose should be given, as you are not hypo until that point. There was written instruction this time on my notes to keep my BG at 5 or above. They had no understanding of the modern method of working out insulin/carb ratios, despite the fact that the drip is set up with a set ratio. In this instance they had set it at 2:1 (that's 2 insulin to 1 carb, I'm not sure if I've written it the right way round) when at night I would need 1:1, i.e. nothing at all because my lantus would keep it balanced with no input of either insulin or glucose. A junior doctor who (poor woman) had been left in charge of goodness knows how many wards all on her own for the night, tried to tell me how to manage my diabetes as if I was just diagnosed instead of having over 30 years experience. She was rude and bombastic and refused to accept anything I said as truth.
I believe that the sliding scales of old are obsolete with current knowledge. All a type 1 needs in those circumstances is a glucose drip set up to be activated only if the BG goes lower than the threshold that the particular patient is safe with, and that is different for most people, although it is recommended by the Powers that Be that under 5 is not good. The uneducated doctor I saw that night said that the drip was to prevent me going hyper, not hypo. Of course she didn't know what she was talking about, and a drip for that purpose is unnecessary because we can all inject insulin if necessary and not rely on a drip set up by a non-specialist with only generic instructions from their Book of Words. They also use only actrapid insulin and refuse to use anything else. I don't know of anyone on actrapid nowadays: it has been superseded by much better insulins long since. An actrapid induced hypo is about the worst thing that can happen. I haven't had a really bad hypo since I have been off the stuff. When it came out it was a huge step forward, but now it feels as if it is prehistoric.
I have offered to take part in education programmes for hospital doctors and nurses and an insistence that the hospital policy is changed in light of modern diabetes treatments.
I'll keep you posted about results.
The incident was one of being on a sliding scale of insulin/glucose for the fasting night pre-op. Every time I have been on one, the scale has been set wrong for my own needs and I have been allowed to go hypo. The hospital has a policy that a BG of 3.7 is the point at which glucose should be given, as you are not hypo until that point. There was written instruction this time on my notes to keep my BG at 5 or above. They had no understanding of the modern method of working out insulin/carb ratios, despite the fact that the drip is set up with a set ratio. In this instance they had set it at 2:1 (that's 2 insulin to 1 carb, I'm not sure if I've written it the right way round) when at night I would need 1:1, i.e. nothing at all because my lantus would keep it balanced with no input of either insulin or glucose. A junior doctor who (poor woman) had been left in charge of goodness knows how many wards all on her own for the night, tried to tell me how to manage my diabetes as if I was just diagnosed instead of having over 30 years experience. She was rude and bombastic and refused to accept anything I said as truth.
I believe that the sliding scales of old are obsolete with current knowledge. All a type 1 needs in those circumstances is a glucose drip set up to be activated only if the BG goes lower than the threshold that the particular patient is safe with, and that is different for most people, although it is recommended by the Powers that Be that under 5 is not good. The uneducated doctor I saw that night said that the drip was to prevent me going hyper, not hypo. Of course she didn't know what she was talking about, and a drip for that purpose is unnecessary because we can all inject insulin if necessary and not rely on a drip set up by a non-specialist with only generic instructions from their Book of Words. They also use only actrapid insulin and refuse to use anything else. I don't know of anyone on actrapid nowadays: it has been superseded by much better insulins long since. An actrapid induced hypo is about the worst thing that can happen. I haven't had a really bad hypo since I have been off the stuff. When it came out it was a huge step forward, but now it feels as if it is prehistoric.
I have offered to take part in education programmes for hospital doctors and nurses and an insistence that the hospital policy is changed in light of modern diabetes treatments.
I'll keep you posted about results.
