Hospitals and diabetes

[Andrew2018]

Hi,
Sadly I have been in hospital three times in the last few months, unscheduled visits, and not diabetes related, so obviously not carrying medications with me. I have found that nurses and even Dr's take note that one is a diabetic type 1, and then promptly ignore it. I have found that the nurses fairly understandably cannot get directly involved with medication, but are surprisingly unaware of the issues of diabetes and blood glucose levels other than administering tests. The Doctors for their part seem to think the dose rate is set by the GP and set in stone !. My last visit, going for an ambulatory ECG on 23rd December, I had a hypotension episode in the unit as I was about to leave. This resulted in being admitted for 24 hours, and my blood glucose levels rising to beyond the range of the Libre monitor, ie over 27. No-one seemed interested even though I pushed the issue, the best was 8 units of fast acting after a meal, nowhere near the required dose, but apparently the Dr would not authorise more, indeed didn't even see me face to face, it was done via a nurse who was not prepared to take time to go back to the Dr. Also notable that no-one has any notion of the carb value of the hospital food, indeed some provided was clearly full sugar etc.
Anyone else have this experience?. It's like they are blinkered to whatever caused the admission to the exclusion of all else. They refused to even see if there was anyone in the Diabetic Unit when I asked ( I am under their Diabetic unit, and they have said to ask staff to let them know if I'm in the hospital), not very helpful.
Be interested in hearing if others have found the same.

 

[EllieM]

I've had a few different T1 experiences in hospital.

My two T1 NHS pregnancies were excellent, they let me do my own thing insulin wise and even gave me access to a kitchen if I needed to access food urgently. Those were general antenatal wards, thirty years ago.

Ten years ago my T1 mother was looked after impeccably in intensive care, but once in the general NHS ward there was no one authorised to change her insulin dose. As she was coming out of multiple organ failure her insulin needs were reducing rapidly, but in the absence of a doctor authorised to make the change the nurses told her she had the option to refuse meds, so she could either skip her basal or her bolus. She opted for the latter because she reckoned she was too weak to eat fast enough to cope with the bolus...

Needless to say when she was finally seen by a doctor from the diabetic team, he was extremely apologetic and told the nurses to give her whatever she wanted.

But it doesn't fill me with confidence about the ability of a general hospital to cope with my insulin needs if I'm not in a position to cope with them myself (intensive care excepted).

 

[plantae]

Not related to medication, but when I was recently in hospital they swapped me to a "diabetes menu" so they took away the roast chicken and vegies that I'd ordered for dinner and gave me 1 piece bread, a bread roll, a plate of pasta with tomato sauce and ice-cream. It didn't make a lot of sense

 

[jjraak]

Well I'm not T1 but T2, but my experience of the food was pick well, because it's all poor for anyone wanting lower carbs

As for meds, it is very restrictive.

I'm asthmatic, But was in for major trauma surgery

Post op, covid running rampant in hospital, I begin getting signs of impending asthma issues

Asked for a preventer inhaler.
(On my repeat go prescription) ...hadn't thought to get any asthma meds brought to hospital, (very far from home )
LCHF had put my asthma into some sort of remission.

And most likely the anxiety over covid causing me to have psychosomatic asthma symptoms.

But regardless, I was becoming more worried & breathing was getting harder

Wasn't issued with new preventer or reliever until next day.

Everyone all apologetic but they couldn't do, etc etc .

Sure if I collapsed I'd have been seen to asap, but the wait to manage for myself, was distressing.

Must be a better way to let us treat as we would normally on a daily basis, with some overview of possible risks, rather then ignore us completely.

 

[becca59]

Rationale

Adults with type 1 diabetes may be admitted to hospital for diabetes-related or unrelated conditions. This can disturb normal routines, affecting carbohydrate intake and insulin therapy, and special regimens may be needed in response to procedures that affect the usual management of diabetes. The person's expertise in managing their own diabetes should be respected, and the specialist multidisciplinary team has the knowledge to help the person understand how best to adapt management when in hospital. The person should be supported to continue to self-manage their diabetes and administer their own insulin if they are willing and able and it is safe for them to do so. Input from a multidisciplinary specialist team can reduce the length of hospital stay for adults with type 1 diabetes and improve their experience of hospital.

Just copied this from the NICE guidelines.

 

[Nicola M]

My experience has been varied, all the admittances to the hospital that I remember whether my treatment for insulin was good/bad are for DKA which admittedly isn't the best reason to be in hospital but none the less you'd think they'd be better at giving insulin for that scenario. On one occasion I was on a sliding scale and was told if my blood sugars were within range for the next couple of hours they would let the doctor know that I was good to go which was great until the insulin ran out... at the time my sister was with me and we both told them on multiple occasions the insulin is out I need some more and it was if they weren't bothered, unsurprisingly the next time they came to get my blood sugar I was a little high and only then did the realization hit that the insulin was gone. I've found unless I am moved to the diabetes wards the care towards diabetes is pretty poor as they don't seem to understand how important our treatment is for us.

 

[Deleted member 527103]

I have limited experience of being admitted with diabetes without planning. However, as i never leave the house with my diabetes kit so always have my insulin and tester with me. When I have been in hospital, I insisted on keeping my kit with me and was able to administer it myself.
I guess I have been lucky that I have never been in a situation when I have to rely on others as that is my worse nightmare (hence fighting to keep my insulin).

 

[Deleted member 475901]

Last time I was in hospital, before diabetes, I took in enough of my bag of meds to last me at least one extra day. I expected them to take the meds off me, as had happened several times in the past, but the nurse handed them back and told me to manage my own pain levels (I was on codeine and pregabalin plus other meds).
I was very pleased as several times they'd missed my meds or been so late it caused issues when in before that.
If in for planned surgery I ask during the preop session with the anaesthetist, or other than that use my phone to call my GP/out of hours service from the ward!

But as a diet controlled T2 I dread going in now because the food could make me ill enough to need metformin at least.

 

[JAT1]

I was in the hospital burn unit for one month recovering from burns to 20% of my surface area, so serious I underwent 2 operations for skin grafting. Fortunately I was allowed to manage my own diabetes (type 1) and the hospital provided the same kinds of insulin I used at home. I was put on the 'diabetes and high protein diet'. I lost weight and went to 90 lbs at 5'3". The food portions were so small, even though I was down for twice the usual helpings. I was glad I am type 1 and could determine the amounts of insulin I required because the diabetes diet was very high carb food, including sweet muffins, fruit in sugar syrup, etc, at every meal and I had to eat plenty to recover. A diet from hell for a type 2. Most of the nurses were very kind, interested in diabetes and cooperative with my dosing needs, while a small minority were quite nasty. I was extremely lucky, survived, and am grateful everlasting.

 

[Andrew2018]

Rationale

Adults with type 1 diabetes may be admitted to hospital for diabetes-related or unrelated conditions. This can disturb normal routines, affecting carbohydrate intake and insulin therapy, and special regimens may be needed in response to procedures that affect the usual management of diabetes. The person's expertise in managing their own diabetes should be respected, and the specialist multidisciplinary team has the knowledge to help the person understand how best to adapt management when in hospital. The person should be supported to continue to self-manage their diabetes and administer their own insulin if they are willing and able and it is safe for them to do so. Input from a multidisciplinary specialist team can reduce the length of hospital stay for adults with type 1 diabetes and improve their experience of hospital.

Just copied this from the NICE guidelines.

Interesting. Certainly it's my experience that the general ward teams seem extremely reluctant to even attempt to liase with their own hospitals specialist diabetic team. It's something I will be taking up with the Diabetic unit when I visit on the 11th to discuss my current insulin issues.

 

[Andrew2018]

Seems I'm not alone then, a bit worrying. The other issue I couldn't believe was the proverbial bed blocking. Three of us were waiting for discharge for over 6 hours just because the hospital pharmacy hadn't supplied medication. For my part, I realised that I could perhaps magnify the small print of the discharge letter with my phone, ( not having my reading glasses with me ), saw it was a drug I had been taking, had at home etc, so I advised them and asked to leave without it. That left the other two still waiting in growing frustration, and the ward short two beds. Chaos.

 

[Ushthetaff]

Whenever I’ve been in hospital I’ve been left to my own devices ! Which is fine by me ! My experience is that a blood sugar reading is taken before meals and put on a chart as far as insulin dosage that is up to me , was even told well you’ve had diabetes that long you probably know more about than I do ….and in many cases that is a true statement