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has the hospital failed me!

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garrybrown70

Newbie
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1
Hi
I am type 1, i went into hospital for an operation and was on a sliding scale, my question is how did i go into ketoacidosis and end up in intensive care.

Should i sue the hospital.

Regards
Garry
 
Just how often were your blood glucose levels tested as no one should go into DKA especially with nurses taking care of the sliding scale?
 
Unfortunately, this is far more common than anyone would hope. I can't remember the figures but the National Diabetes Audit for Impatients found that a lot of diabetics end up in DKA after a spell in hospital. In fact, there was something on the news this week about a diabetic who died after not being given insulin whilst in hospital.

In no solicitor, but I'd consider legal advice.
 
I suspect hospitals might make a mess of sliding scale as I understand it assumes a set amount of carbs in a meal which I can't imagine a hospital managing well. Carb counting might work better IF you are allowed to calculate and do your own Bolus. To go into DKA in hospital is inexcusable and I think a formal complaint is the minimum needed.
 
garrybrown70 said:
Hi
I am type 1, i went into hospital for an operation and was on a sliding scale, my question is how did i go into ketoacidosis and end up in intensive care.

Should i sue the hospital.
Click to expand...


I wouldn't like to advise on that matter Garry, strange how they managed to let things slip so bad as when I was last in hospital for a operation on a sliding scale my bg never went above 5.5mmol :?
 
Its strange how things seem to have changed. 30 odd years ago, a friend went into hospital for heart by-pass (spaghetti junction) surgery, she was type 1. She asked them to administer her insulin injections as they would be able to reach the parts that she couldn't, there by giving the regularly used sites a rest, after all the needles were a bit bigger back then. They refused, saying that she was perfectly capable of administering her own insulin. Given the state of the NHS today, I would have thought it would be better for any one that has to spend time in hospital to be in control of their own medication, but now they take it all away from you and make a right old mess of things. :thumbdown:
 
as I understand it assumes a set amount of carbs in a meal which I can't imagine a hospital managing well
Click to expand...
Well, no. Sliding scale continuously adjusts insulin infusion rates based on BG which is measured every hour; if you eat a lot of carbs (note that it's frequently used alongside glucose IV) then BG goes up, is detected within an hour and the insulin infusion rate is adjusted to bring it back down. Read all about it here.

There is nothing inherently wrong with the sliding scale regime that causes DKA (note that binging on carbs can't cause DKA to begin with - harmfully high BG, sure, but not DKA) and I suspect a failure to adequately monitor BG and/or to correctly apply the sliding scale rules.

I would have thought it would be better for any one that has to spend time in hospital to be in control of their own medication, but now they take it all away from you and make a right old mess of things.
Click to expand...
The official recommendation is that patients should continue managing their own medication whenever possibly; however, in certain situations that may it be possible (e.g. NBM for surgery)
 
Sorry Alex, I should have a dded 'when its physically or menta lly possible for them t o do so ' - b ut i have a very dodgy keyboard that puts in lots of extra spaces so I have to go back over the who le thing and edit out al l the extra ones and just got fed up with doing it - oooops.
 
Im type 2 was insulin controlled, I went in for an op last year I was in control of my own medication and blood testing. I would not like someone else to be in control of my meds. I would complain without a doubt if that had happened to me!
 
AlexMBrennan said:
as I understand it assumes a set amount of carbs in a meal which I can't imagine a hospital managing well
Click to expand...
Well, no. Sliding scale continuously adjusts insulin infusion rates based on BG which is measured every hour; if you eat a lot of carbs (note that it's frequently used alongside glucose IV) then BG goes up, is detected within an hour and the insulin infusion rate is adjusted to bring it back down. Read all about it here.

There is nothing inherently wrong with the sliding scale regime that causes DKA (note that binging on carbs can't cause DKA to begin with - harmfully high BG, sure, but not DKA) and I suspect a failure to adequately monitor BG and/or to correctly apply the sliding scale rules.

I would have thought it would be better for any one that has to spend time in hospital to be in control of their own medication, but now they take it all away from you and make a right old mess of things.
Click to expand...
The official recommendation is that patients should continue managing their own medication whenever possibly; however, in certain situations that may it be possible (e.g. NBM for surgery)
Click to expand...

The sliding scale is an interesting one, because I was on a sliding scale in 2000. After my emergency admission, I didn't eat for days, so no carbs at all and my blood sugars were mostly in the 15 range. I was monitored every hour, day and night.

RRB
 
Garry,

Sorry to hear that you have been so unwell. I hope that, ketoacidosis aside, the operation and recovery went well.

I had an op last year and was also on a sliding scale. I could not sit up for 48 hours and was not able to move enough to do my own injections or BMs. One night I started being sick so pressed the buzzer. Nurse came and checked me levels - "hi". She then told me that the drug round was in an hour and they would give me some insulin.

I complained to the patient liaison service (PALS) once I was out. I got a reply but not a lot else.

I know the hospitals roll out the "think glucose" scheme but there still seems to be many nurses and so on who don't understand the dangers of high blood sugar. I also had a low sugar when I was in hospital. I was brought a sugar free yoghurt and one of those info vitally wrapped cheeses. Helpful, eh?! Thankfully, a doctor came along and have me some very sugary and foul tasting liquid to drink. At least it did the job!

My surgeon was appalled at my sugar control post op and told me that I had left myself open to delayed healing time, infection, wider scars and so on. I was so angry as, for the first few days, it was completely out of my control. Once I was back to doing my own injections I did find that my sugars were all over the place cue to the anaesthetic, general inactivity and so on. I just tested more regularly and managed to maintain pretty good control.

If I were you I would start by talking to PALS. they can provide you with a copy of the complaints procedure and are usually the first step on the ladder. I'm not sure that suing is the right way to go but definitely report it and see how you go. If you do decide to take legal action it may be worth contacting the CAB on something.

Good luck and I hope the rest of your recovery is smooth.

Take care,
Em x


Sent from the Diabetes Forum App
 
The food in hospital is usually a joke for diabetics which does not help. Just spent three days inside, and bg's went higher than normal thanks to the NHS hospital diet of white bread and jam for breakfast, more bread for lunch (sandwiches) and tempting dinners such as pie with no veg (just a slice of pie on a plate) and sponge with custard for dessert. After two days they managed to get the dietician to provide me with the carb count of all the hospital meals but this was 2 days into a 3 day stay so for 2/3 of the time I was guessing my carbs. The nurses would ask me 'what's your insulin dose for your meals' and i'd have to explain time and time again that it DEPENDED.

Luckily they let me do all my own testing and injecting, suprising as I was at the famous hospital that was in the news about a couple of years ago because patients were being killed by someone going round injecting them with insulin, so all insulin is supposed to be kept under lock and key now. Which doesn't help us diabetics.

Anyway if I were you I'd definitely make a complaint and get it investigated. Good luck.
 
The food in hospital is usually a joke for diabetics which does not help. Just spent three days inside, and bg's went higher than normal thanks to the NHS hospital diet of white bread and jam for breakfast, more bread for lunch (sandwiches) and tempting dinners such as pie with no veg (just a slice of pie on a plate) and sponge with custard for dessert. After two days they managed to get the dietician to provide me with the carb count of all the hospital meals but this was 2 days into a 3 day stay so for 2/3 of the time I was guessing my carbs. The nurses would ask me 'what's your insulin dose for your meals' and i'd have to explain time and time again that it DEPENDED.

Luckily they let me do all my own testing and injecting, suprising as I was at the famous hospital that was in the news about a couple of years ago because patients were being killed by someone going round injecting them with insulin, so all insulin is supposed to be kept under lock and key now. Which doesn't help us diabetics.

Anyway if I were you I'd definitely make a complaint and get it investigated. Good luck.
 
When I was in hospital earlier this year I took own bloods and meds however I was shocked that they gave a choice of main courses... But puddings were always icecream!!! Is this normal now for hospitals just to give such puds as sponge n custard or just icecream. I must admit I was shocked... Guestimated my foods quite accurately but that was only luck as I normally dont have icecream... Wasnt as if they had excuse that it was an op on mouth or face.....
 
It is worth trying to get a copy of the nutritional information for the hospital food, as the dietician had all this on a list so I could carb match (even if it took me two days to get it). I think they have to provide it. Doesn't guarantee the portion size is accurate but it's a start. I have heard they have £8 per patient per day for food at my hospital.
Interestingly, m and s have built an m and s food shop within the grounds of the hospital as I think they've realised they are on to a winner selling nice food to the poor hospital patients who get rubbish! Of course these are all carb/cal counted if you can stomach the eye watering prices!
M and S clearly know how to make money, perhaps we will see more of these at other hospitals in the years to come.

I was surprised that the nurses didn't seem to understand that my dosage would change depending on the content of the food, I know they are not DSNs but general nurses but with the prevalence of diabetes in hospitals these days you'd think they would at least get that.
 
garrybrown70 said:
Hi
I am type 1, i went into hospital for an operation and was on a sliding scale, my question is how did i go into ketoacidosis and end up in intensive care.

Should i sue the hospital.

Regards
Garry
Click to expand...
Hi Gary,
Just contact an expert medical negligence solicitor for free advice ,they will be able to assess your chances of pursuing a successful claim, it may also be necessary to highlight negligence in your case.

Roy.
 
My pre op sugars were terrible on a sliding scale also but no DKA luckily ! I was NBM but they must have got the ratios wrong as my levels kept climbing,was glad when I got my insulin pen back and took control of my own diabetes.

Garry,sorry this happened to you and as others have said certainly look into taking further action.

Best

Paul
 
the_anticarb said:
The food in hospital is usually a joke for diabetics which does not help. Just spent three days inside, and bg's went higher than normal thanks to the NHS hospital diet of white bread and jam for breakfast, more bread for lunch (sandwiches) and tempting dinners such as pie with no veg (just a slice of pie on a plate) and sponge with custard for dessert. After two days they managed to get the dietician to provide me with the carb count of all the hospital meals but this was 2 days into a 3 day stay so for 2/3 of the time I was guessing my carbs. The nurses would ask me 'what's your insulin dose for your meals' and i'd have to explain time and time again that it DEPENDED.

Luckily they let me do all my own testing and injecting, suprising as I was at the famous hospital that was in the news about a couple of years ago because patients were being killed by someone going round injecting them with insulin, so all insulin is supposed to be kept under lock and key now. Which doesn't help us diabetics.

Anyway if I were you I'd definitely make a complaint and get it investigated. Good luck.
Click to expand...

I fear this is typical of what goes on in the majority of hospitals nowadays as the average nurse who works in hospital wards will have no idea whatsoever of how basal/bolus insulin and adjusting ratios according to the carb content of food, works. Hospital D consultants and DSNs will know but the average SRN, well no :roll:

Things were a lot better years ago for diabetics who went into hospital when they using twice daily insulins and all that was needed was for the diabetic to 'eye up' the food on the dinnerplate and try to keep the carb content within their allowance for the meal, therefore not having to work out a ratio for the amount of bolus insulin that needed to be used. Food choice was much better as well from what I can remember. I had a choice of small, med or large portion sizes of vegetables , a choice of meat and a choice of custard/sponge, icecream or plain fruit. Unfortunately, the nursing staff working in hospital wards will only know of the twice daily regime so that is why all manner of food is served up and for the diabetics who are not well enough to give themselves their insulin jabs, will have to rely on having set doses of bolus insulin regardless of the carb content.
 
In some ways you were lucky, you are still with us. The next person might not be so lucky

As has already been suggested make an official complaint and escalate your action until you get a positive response. You want to know what they are going to do to make sure it never happens again. If they don't answer that keep on at them.

If that means taking the hospital to court, do so for everyone's sake. Check out http://www.ombudsman.org.uk/, they have a guide to complaining about the NHS and can take on a case when teh NHS have failed to adequately deal with it.

We all need to make the cost (in pounds sterling) of getting it wrong more than the cost of getting it right because it seems hospital managers only understand money!
 
HI Garry

Yes your hospital has failed you.
There is no need for anyone to go into DKA whilst on a sliding scale as long as the hospital staff know what they are doing!!!

Unfortunately this almost happened to my 28 year old daughter. Whilst on a sliding scale the nurse came and switched off the insulin as her blood sugar had dropped despite my daughter telling her it was the wrong thing to do. Fortunately my daughter's specialist nurse had come on the ward to see her and noticed this straight away and demanded to know why they had done this. The nurse replied i'm not trained but we are short staff and I was told to see to it.
The specialist nurse told her under no circumstances should either the insulin or glucose be turned off, and filed a report to say more training needed to be given.

I feel every person who has diabetes deserves a high standard of care when in hospital, and for you to experience DKA whilst on a sliding scale shows you certainly wern't given that. Instead they put your life at risk.

Whatever you decide to do it needs bringing to their attention that this was unacceptable.


:(
 
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