Disappointed with NHS care of mum today

[mouseee]

Apart from venting to people who understand, would love to know opinions of what I should expect in terms of my mums care inc diabetes in hospital.

She is T2 insulin, has been for 30 yrs. I don't feel it's particularly well controlled and there sure is a lot of chocolate around her flat....

She's in having just been dxd with heart failure, waiting for next steps to be decided. I'm very aware that this is likely to be linked to her T2 and not being as controlled as she could be for many yrs.
That parts fine. However, panicked phone call from my sister this morning as they had just spent a long while trying to get her bs back up from 1. She said she'd found her head lolled, sweaty and unresponsive. The staff had tried to get her bs up by making her drink glucose of some kind.

Now, I'm T2, and still learning lots about all forms but I have worked with 2 different children through work who are T1. My limited training told us, at the point my mum was, they wouldn't be able to drink and to use glucogel inside the mouth to be absorbed. I seem to remember one also had a glucose injection kit of some kind. So, why didn't the ward have access to this or why didn't they know that was what they needed to do?

She also hasn't seen a dsn since being in and I am unconvinced the food being provided is the best it could be. She's never crashed like that before and I think they should be monitoring her more closely for bs tonight and tomorrow at the least.

What do I say to the nurses tomorrow to make sure she has the care she needs for her diabetes?

 

[MeiChanski]

Hello, oh dear, I’m so sorry and I’m quite surprised they didn’t know how to administrate glucose. Is your mum better now? I was told that when someone is unconscious, even glucose gel is dangerous because of choking. They should have a glucagen kit? Or administrate glucose through an injection? I was unconscious and paramedics didn’t put anything in my mouth, they injected into my veins. Usually you can get them on prescription, maybe you can ask your mum's diabetes team or GP for information on it. I’ll tag @Mel dCP

 

[HSSS]

Having no experience personally of insulin you might want to remember this in what I am to say but if it were my mum I’d want to know
How it happened? (Too much insulin given? Readings not checked?) it should all be documented
Why they treated it the way they did?
Who is administering her insulin?
Are they following her normal regime?
If not who ordered the changes and why?
Has the hospital diabetic team seen her? If not why not?
What is she eating? Does she carb count? Does she have access to the right info to do this?

Some questions might have valid replies but this is where I’d start

 

[mouseee]

I spoke to her about an hour ago and she was ok but the event was confused in her mind. I told her to check her bs every hour tomorrow which maybe overkill but I want her to monitor herself properly tomorrow. That way she'll do it at least more than once!

 

[EllieM]

I am not surprised this happened over a weekend.

8 years ago my 78 year old T1 mother was in a general ward (in the South of England, she didn't want me to complain about the hospital so it shall remain nameless for now) after 10 days in intensive care, with multiple organ failure.
She was in recovery, so not surprisingly her insulin needs went down from the high (for her) levels that were needed in intensive care (who looked after her and her diabetes wonderfully). She was very frail and could not even do her own injections. Not surprisingly, the first night in the ward she had a series of bad hypos, which the ward sisters semi ignored - she had hallucinated while in intensive care because of her illness. The next day (Saturday) she knew her insulin doses needed to be lowered but the ward sister was unable to find a diabetic specialist to authorise this and her only option was to refuse either her basal or bolus insulin. She opted to refuse the bolus, because she was too weak to quickly eat the large quantities that would have been required if she'd taken it. Though that of course meant that she was now committed to 24 hours more of excess basal.

24 hours later the diabetic specialist was extremely apologetic as he told the nurses to allow her any quantity of insulin she asked for....
According to my mother, and my observations agreed, the ward was very understaffed (piteous calls for help from patients who'd wet their beds in adjacent room), some patients had call buttons that did not work, and she found the night nurse's treatment of the dementia lady with a broken bone (hip?) opposite her to be borderline sadistic (obviously I did not see this because it was at night). The nurses had very little clue about T1, though they did their best.

I fear ever being stuck in a hospital at under 100% mental capacity or too frail to do my own injections....

And back to the original issue, surely with a blood sugar in the 1s she should have gone onto a glucose drip? I don't understand why they could not call a doctor, but suspect the fact that it was a weekend had something to do with it.

And on a more cheerful note, @mouseee , that is one adorable avatar.

 

[Energize]

The nurse who was initially alerted should, in my opinion, quickly see and assess your mother re conscious level, whether she could swallow on instruction. Having determined she was not conscious, she should have immediately called the doctor as an emergency call.

As already mentioned, I would have thought some emergency hypo kit would be readily available and a member of staff who knew how to use it properly.

I do hope your Mum is OK and that they monitor her better as a result of this incident. {{{Hugs}}} to you

 

[TriciaWs]

My experiences, both myself and t1 & t2 friends, recently indicate that most medical staff seem to be confused about current advice and treatment.
And my local hospital doesn't provide low carb meals.

 

[DavidGrahamJones]

What do I say to the nurses tomorrow to make sure she has the care she needs for her diabetes?

A similar thing happened to my father. His problem was that at home he was eating chocolate all the time along with muesli, toast and honey (because it's healthy). In hospital there were not the treats but the same amount of insulin. It was several days before they reduced the insulin which of course had to be increased as soon as he got home.

My own experience in hospital is that nursing staff seem to be a little lacking in knowledge. I wouldn't blame them, I guess it's considered to be a specialist subject.

I think they should be monitoring her more closely for bs tonight and tomorrow at the least.

I've often thought that for £50 (£35 to the NHS), the price of a Freestyle Libre Sensor, they could monitor someone for two weeks, and with the new sensors, now long overdue, they could have warnings as well. The savings in nurse's time would be enormous (sorry if that's over exaggerating). The savings would certainly be more than the £35 paid for each sensor.

 

[KK123]

All I would say in addition to the great replies above, is ALWAYS speak to the Ward staff and any Consultant or Doctor you can get your hands on at the hospital, even if it means waiting to see them. Double check the records as well, even those that are kept around the Nurses station, not just the ones at the end of the bed. I have had 40 years of these experiences (with my type 1 Mum) and believe me when I say there have been numerous mistakes made which nearly finished her off. Don't be fobbed off by any medical staff, be pleasant, well informed and above all proactive in your Mum's care. We would drop in unexpectedly at meal times regardless of their protected status because we KNEW nobody would ensure my Mum so much as ate her meal or even whether she would have had her injection on time. I am not having a go at Nurses by the way, mostly they were a lovely bunch of people but they simply did not know how to treat a patient with diabetes on a ward for another condition.

 

[KK123]

A similar thing happened to my father. His problem was that at home he was eating chocolate all the time along with muesli, toast and honey (because it's healthy). In hospital there were not the treats but the same amount of insulin. It was several days before they reduced the insulin which of course had to be increased as soon as he got home.

My own experience in hospital is that nursing staff seem to be a little lacking in knowledge. I wouldn't blame them, I guess it's considered to be a specialist subject.



I've often thought that for £50 (£35 to the NHS), the price of a Freestyle Libre Sensor, they could monitor someone for two weeks, and with the new sensors, now long overdue, they could have warnings as well. The savings in nurse's time would be enormous (sorry if that's over exaggerating). The savings would certainly be more than the £35 paid for each sensor.

Hi David, 'a little lacking in knowledge' is an understatement, most did not have a clue how it worked, they simply think insulin followed by a meal, timings, what's that?, amount of carbs, eh?, insulin before or after, erm, not sure!!! and on and on.

 

[DavidGrahamJones]

'a little lacking in knowledge' is an understatement,

Only referring to my experience. I can see your experience is different.

 

[Daibell]

If you are able to still handle it, always insist on keeping your insulin yourself in hospital and doing your own injections. Don't allow nurses to lock it away. Let the staff test you as often as they like but always do your own insulin if you are in a suitable state.

 

[JAT1]

I fear ever being stuck in a hospital at under 100% mental capacity or too frail to do my own injections....

So do I !

 

[mouseee]

Thanks everyone. I had a long chat with my mum over the phone last night and by the time I got to her this pm she had seen the DSN. She now has a glucose jab for emergencies in the fridge on the ward and will have some to take home eventually.
As earlier poster have said, I reckon she's eating a lot less in hospital than at home and her numbers are always quite high on a day to day basis. She says this is her 'normal' but haven't had that conversation with her yet!!
She had a chat with the sister on the ward today too. They apparently followed procedure and she did have dextrose IV but not a drip.
The DSN has dropped her insulin to a 10, 12, 14 split over the day. But my mum was surprised I was asking how she is to adjust that for the carbs she has with each meal. I have told her to request the carb count for each meal to record and compare with her bs and to check 2hrs after eating as well as before. They don't provide that and it's not in the menu they get given either (which incidentally lists jacket potatoes as suitable for T2).

They are being so good at the rest of her care but this is quite important!

I have no idea how I would cope in hospital as the menu is impossible to eat LC from. My bs would go up to a point I don't even want to think about.

 

[EllieM]

I have no idea how I would cope in hospital as the menu is impossible to eat LC from. My bs would go up to a point I don't even want to think about.

I suspect you'd rely on food brought in by friends or family members....