Hospital admission for monitoring/observation

ChloeS

Newbie
Messages
1
Type of diabetes
Parent
Treatment type
Insulin
Wanting to hear from anyone else who has had this experience - basically what to expect/is there something else going on here which diabetes clinic are not telling me. Daughter is 10 years old, diagnosed 3.5 years ago. She is very independent at self-managing and has a Libre. There have been episodes of snacking without injecting which I though had ceased but am now tightly watching for. Consultant at clinic in February this year was happy with evidence of management in terms of recording and knowledge but (which I agreed with) felt her HbA1c (71) was not good enough - her advice was to consider a pump which we agreed with and I understood that daughter was to be added to the local waiting list for this.

This June a different consultant pulled us in for an early unscheduled appointment, said that daughter's then HbA1c of 76 was putting her at risk of imminent hospital admission (daughter has not had an admission since diagnosis) and insisted on much closer monitoring and manual recording (as well as recording in Libre app) which we are still doing and overall I thought things were improving though far from perfect (identified issues of daughter undercorrecting if not monitored though always bolusing correctly for food and not always bolusing for food immediately when outside house, and unexplained highs frequently but not consistently overnight), judging from appointment we had in August. Further appointment this week (when I explained again that we had agreed to a pump, which neither this consultant nor the DSN apparently knew about) and consultant is insisting on hospital admission for daughter for 3-4 days to identify cause of erratic levels. She presented this as a routine intervention but I have not come across this scenario of hospital admission when there isn't a history of clinical problems caused by DKA or hypo.

Am assuming that intention is to see if levels are still erratic when daughter is essentially in a closed environment and supervised by someone other than parents/school/out of school care (so finding it hard to believe that basically I'm not trusted to care for daughter though I know this is not a helpful way to think) but keen to hear from anyone else with experience of this.
 

Nicola M

Well-Known Member
Messages
695
Type of diabetes
Type 1
Treatment type
Pump
I've never heard of this being a thing although I don't necessarily see it as a bad thing either. Whilst I understand your viewpoint that it seems like they're trying to say you aren't caring for your daughter properly I think it's seen more as a way to gather information more accurately on what is going wrong to cause a high HbA1c. All they've got to go on is what you're saying you are doing and from the sounds of it you thought you were doing better but the results aren't reflecting that so something is going wrong somewhere, by having them assess her themselves they can see exactly what is going wrong and work up a treatment plan to bring her HbA1c down to more normal levels.

Pre-closed loop I had a HbA1c of 78 which is pretty close to your daughter's current level of 76. You run the risk even at her age of having complications if it stays that high. When mine was 78 I was above 14mmol pretty much every single day. Based on information from Abbott (photo attached) with a HbA1c of 76 she is only in range roughly 40% of the time whereas the usual recommendation is at least 70% of the time.

Diabetes is a difficult chronic disease and at 10 years old self-managing will not be easy, at the end of the day she is still a child and although you can follow behind her and do your best to monitor her yourself you can and will miss things, no one is perfect and even as adults we miss stuff. I think she and you will benefit from closer monitoring and if they can figure out what's going on once they bring her levels down she will feel a lot better within herself as well.

If they can get her on an insulin pump (and especially one that links to a CGM) I think that would help massively with her control.
 

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David Paul

Member
Messages
14
Type of diabetes
Type 2
Treatment type
Diet only
Wanting to hear from anyone else who has had this experience - basically what to expect/is there something else going on here which diabetes clinic are not telling me. Daughter is 10 years old, diagnosed 3.5 years ago. She is very independent at self-managing and has a Libre. There have been episodes of snacking without injecting which I though had ceased but am now tightly watching for. Consultant at clinic in February this year was happy with evidence of management in terms of recording and knowledge but (which I agreed with) felt her HbA1c (71) was not good enough - her advice was to consider a pump which we agreed with and I understood that daughter was to be added to the local waiting list for this.

This June a different consultant pulled us in for an early unscheduled appointment, said that daughter's then HbA1c of 76 was putting her at risk of imminent hospital admission (daughter has not had an admission since diagnosis) and insisted on much closer monitoring and manual recording (as well as recording in Libre app) which we are still doing and overall I thought things were improving though far from perfect (identified issues of daughter undercorrecting if not monitored though always bolusing correctly for food and not always bolusing for food immediately when outside house, and unexplained highs frequently but not consistently overnight), judging from appointment we had in August. Further appointment this week (when I explained again that we had agreed to a pump, which neither this consultant nor the DSN apparently knew about) and consultant is insisting on hospital admission for daughter for 3-4 days to identify cause of erratic levels. She presented this as a routine intervention but I have not come across this scenario of hospital admission when there isn't a history of clinical problems caused by DKA or hypo.

Am assuming that intention is to see if levels are still erratic when daughter is essentially in a closed environment and supervised by someone other than parents/school/out of school care (so finding it hard to believe that basically I'm not trusted to care for daughter though I know this is not a helpful way to think) but keen to hear from anyone else with experience of this.
Wanting to hear from anyone else who has had this experience - basically what to expect/is there something else going on here which diabetes clinic are not telling me. Daughter is 10 years old, diagnosed 3.5 years ago. She is very independent at self-managing and has a Libre. There have been episodes of snacking without injecting which I though had ceased but am now tightly watching for. Consultant at clinic in February this year was happy with evidence of management in terms of recording and knowledge but (which I agreed with) felt her HbA1c (71) was not good enough - her advice was to consider a pump which we agreed with and I understood that daughter was to be added to the local waiting list for this.

This June a different consultant pulled us in for an early unscheduled appointment, said that daughter's then HbA1c of 76 was putting her at risk of imminent hospital admission (daughter has not had an admission since diagnosis) and insisted on much closer monitoring and manual recording (as well as recording in Libre app) which we are still doing and overall I thought things were improving though far from perfect (identified issues of daughter undercorrecting if not monitored though always bolusing correctly for food and not always bolusing for food immediately when outside house, and unexplained highs frequently but not consistently overnight), judging from appointment we had in August. Further appointment this week (when I explained again that we had agreed to a pump, which neither this consultant nor the DSN apparently knew about) and consultant is insisting on hospital admission for daughter for 3-4 days to identify cause of erratic levels. She presented this as a routine intervention but I have not come across this scenario of hospital admission when there isn't a history of clinical problems caused by DKA or hypo.

Am assuming that intention is to see if levels are still erratic when daughter is essentially in a closed environment and supervised by someone other than parents/school/out of school care (so finding it hard to believe that basically I'm not trusted to care for daughter though I know this is not a helpful way to think) but keen to hear from anyone else with experience of this.
Two points: 1- Have you requested that you are permitted to stay with your daughter during her stay in hospital?
2- Regarding the HBA1C situation, this is such a multi-complex aspect concerning Diabetes; there are many reasons that can be causing this: you mentioned inappropriate dose: however, since diabetes is such a personal chronic disease unique to us on an individual level ( one glove does not fit all with this condition) the multiplicity is enough to drive a person into “wits end corner!”
The hospitalisation may turn out to be a blessing in disguise as there could be underlying issues needing detection.
I hope this helps you as I can feel your helplessness in what is the best course of action to take.
 

sueh500

Newbie
Messages
2
Type of diabetes
Parent
Treatment type
I do not have diabetes
Hi Chloe, I'm the mum of a 12 year old type 1, diagnosed at 9 years old. Since we got past his diagnosis, his HbA1c has been between 37 and 44, so the numbers that you are quoting do seem high to me. I know it's hard, but I think it's a good thing that the consultant is being proactive in sorting this out as something is not working right. I do a lot of the control for my son (I have a medical background and am a scientist so that helps), but it is a lot for them (and us!) to take on at that age and they do need a lot of support. He's always been brilliant about the blood pricks and giving his doses before meals but I always helped him with the corrections, as did his teachers at primary school as they were the trickiest bit, plus reminding him to take his insulin. We have a pump now and closed loop which is a massive help and is programmed to correct, so this does sound like a great way forward for you. In the meantime, it may help for someone to sit down with your daughter and school and remind them of the importance of the insulin and also in helping her grow (most kids are keen to do this!), so she can remember better to take it when you are not around. We did manually record everything for more than the first year too, so we could see which foods were problematic etc. I'm actually going to start doing that again, as there are a few foods that really spike him but I think fairly consistently and it will help to see the patterns. Another thing that really helps for us is consistency - find foods that work well and keep the breakfast and lunch consistent. We found it a nightmare trying to deal with the different school dinners and although school tried really hard to help, there would be changes or he wouldn't like something and it was too complex. So he went on to having the packed lunches, which means that we know what he is getting (he loves his food so usually eats everything) and we can tell him the carbs in advance. Maybe your daughter is regularly underestimating carbs - it can be tricky. Good luck, hope you get it sorted soon!
 
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Jaylee

Oracle
Retired Moderator
Messages
18,232
Type of diabetes
Type 1
Treatment type
Insulin
I can’t help feeling the logic is skewed removing someone from the natural “habitat” for a few days for closed observation of this type just because of a dodgy A1c? That’s not counting the possible unnecessary time taken off school?

It won’t be a true representation of current lifestyle & routines.
 
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lovinglife

Moderator
Staff Member
Messages
4,578
Type of diabetes
Type 2
Treatment type
Diet only
Also at 10 years old she’ll be at the starting end of puberty and all those raging hormones, even as a T2 lady at the other end (menopause) our hormones can be a menace to our BG control
 
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