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managing insulin injections whilst in hospital

quiltergarth

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My husband (80 years old) has Type 2 diabetes well controlled by one daily dose of Lantus solarstar first thing in the morning and three apidra small doses prior to meals.

A month ago he developed an ulcer on his heel, which was treated immediately in our diabetes clinic at our local hospital. Unfortunately it became infected and he developed cellulitis and was taken to hospital. He was quite ill and was put onto antibiotics taken intravenously. During this time he had little or no appetite and the consultant decided to stop all his insulin treatment for the time being. As the infection began to heal,there was some concern that he was still not eating well, so was put onto a glucose drip and was encouraged to eat anything - whether or not it was appropriate for a diabetic. Initially this was a monotonous diet - mashed potato, gravy, vegetables followed by custard or rice pudding . He has now begun to eat a little better, but when I visited him today, to help him with his lunch I noticed he was very very thirsty I looked for the record of his sugar reading in his file, could not find it so decided to bring in his monitor to test his sugar level myself when I returned in the evening. I also decided to take in something more like the diet he follows at home to replace the usual hospital evening meal. This is something the hospital does allow. Before giving him the meal, I tested him and was alarmed to find a reading of 19.8mmol. I spoke to the staff nurse on duty who said that the reading I had was better than the one she had an hour before - 20.4 . She refused to give my husband his usual insulin because there were no notes in his file suggesting this could be done. I was in predicament because I did not see how I could risk give my husband anything to eat given the reading shown on the meter. The staff nurse said the consultant would not be round until Tuesday. Given this I feel I should take matters into my own hands and give my husband his usual insulin injections myself when I visit tomorrow lunchtime. Has anyone any idea what the protocol for this is?
 
As far as I am aware there is no special guidance for T2 diabetics and they simply use the recommendation for T1 diabetics:
NICE CG15:
1.12.3.2 Throughout the course of an inpatient admission, the personal expertise of adults with type 1 diabetes (in managing their own diabetes) should be respected and routinely integrated into ward-based blood glucose monitoring and insulin delivery, using the person with type 1 diabetes' own system. This should be incorporated into the nursing care plan.

1.12.3.3 Throughout the course of an inpatient admission, the personal knowledge and needs of adults with diabetes regarding their dietary requirements should be a major determinant of the food choices offered to them, except when illness or medical or surgical intervention significantly disturbs those requirements.

The staff nurse said the consultant would not be round until Tuesday
Then get her to consult some other less senior doctor.
 
My thoughts on this matter is that a high bg level accompanied by thirst does indeed point to the dire need for insulin to be administered.

I would stay at the hospital tonight until someone senior comes to the ward.... even a DSN who can educate the nursing staff. This type of thing never happened years ago...
 
Hi quiltergarth .

Type2 protocol should be your husbands choice to self administer when he is able to and can do himself or a
trained to inject family next of kin member , when is possible.
He should have actually been asked this question upon admission , when able to eat and sit up, self toilet etc
it is usually encouraged to self administer own insulin.

If been unable to do this himself through illness , the nursing staff usually/should have a careplan to
refer to with this.

I would let the person in charge of the ward - know of your concerns when you next vist your husband.
Explain you are deeply concerned about his extreme thirst and high sugar levels.
If your husband 'wishes' you to assist him with his own insulin administration then it is your
husbands own choice and right to ask for this...

Hospitals operate within 6 care principles and patient charter rights.
Patients own choice being one of these principles :)
If you work within this - you cant go far wrong ...

I was in hospital myself last week and was offered my own choice of insulin regime .
Which I did with a nurse to just assist holding my tummy whilst I injected my own insulin
When my parents and husband came to vist me, they assisted me take my insulin
[I was one armed/handed so needed assistance]

Hope this can help you.
Do let us know how things go .

Anna.
 
With such high blood glucose levels it's totally inappropriate to wait until Tuesday for the Consultant to assess maters, as others have said insist that your husband is seen asap by the ward doctor or a member of the hospital diabetes team.
 
Check out if your hospital subscribes to the "Think Glucose" initiative. If it does, they will have a policy allowing patients to manage their own diabetes.
They should all do this now, but some don't. I was horrifieed that some policies are decided upon to protect the nurses, not the patient. However, the ward staff still have to evaluate the patient's ability to manage themselves.
It's worth discussing this with the consultant in charge of the case. In any case, If this is a diabetic ulcer, it needs the best possible control to get it to heal. I have it on good authority, that the best way of healing a diabetic foot ulcer is to put the foot into plaster, removing weekly to debride and treat and then replastering. This can cut the healing time in half.
Hana
 
I was admitted to hospital approx 7years ago. I had really high blood sugar but they would not let me decide my dose but kept giving me really high carb food to eat! It drove me nuts they had no idea and the combination of sitting around all day as well I had no hope.


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It beggars belief that nursing staff and some doctors are clueless about the affect that carbohydrate has on bg levels.

A diet of mashed pototoe, gravy, followed by rice pudding and custard.......is definately laden with carb and with no insulin well what is to be expected. Its amazing that some nursing staff actually think that insulin is a drug.. What type of training do these nurses get for goodness sake...............
 
Hi,

Insulin is a hormone, but is considered a drug, same as, say adrenaline!

Initially, if unable to self administer, your husband should have been put on sliding scale insulin regime! If he is well enough to self administer, he must be allowed to! I would raise merry hell with the staff, and insist the on call consultant be summoned immediately! Bank holiday weekend is no excuse for lamentably poor care!

:)

Bob
 
Hi all.
Can I just chime in here - I asked for an boiled egg salad . [lunchtime]
A lovely nurse called Natalie went down to the hospital kitchen to collect the last one for me .
Yes even I 'was' suprised at this :o
Natalie then assisted me with my insulin routine after my egg salad lunch .
Have to say I recieved fabulous care and treatment .
Upon leaving hospital I was asked to fill in a survey of their care/clean etc standards .
Maybe the shape of things to come with other hospitals in the future ?

I took in my hospital passport too and stated all my needs and requirements prior to my surgery .
At my pre-op assessment I was given the oppportunity to express my diabetic needs and choices ...
I certainly 'did' this , explained how important it was to me and also expressed my dietry needs ,
plus other stuff that was/is important to me .

Even 'if' I was to be hospitalised with no pre [assessment] available .
I would 'still' request my needs in the same way ' if ' able too . [speak/communicate]
Hubby would be bringing in my hospital passport meds,insulin and would be saying the exact same things to the HCP's .
He 'knows' what I would need and want to have and happen etc ...

Maybe it is worth considering your needs and wants,wishes to be 'confirmed' to your own family members.
Then 'they' can address and push for these if in case you as an individual 'cant' through illness.

IDDT provide the hospital passports 'free' for all types of diabetics...
In these you can write down your wishes and choices .
The ward sister read mine - and commented "well you certainly came prepared!"
All my foods I like/dont like or want/need are in it .
[yep my egg salad was in the list]
Plus my meds needs, insulin routine and choice that I wished to do it if able without assistance .
Hyper/hypo awareness and symptoms to recognise with myself are in it .
My allergies and any other conditions I have - are stated in it too .

I cant stress enough how much this Hospital Passport helped me achieve the very things
I needed and wanted... :thumbup:

Even if a person is taken into hospital as an emergency for/with anything .
A family member 'can' bring it into hospital and request that medical care staff take notice of it .
On mine I also have a sticker stating NO human insulin to be given - 'only' animal insulin .
Reason being, I am with severe medical intollerances and cant tollerate lanctus or levemir insulins!
See how having one of these this CAN make such a difference ...
It certainly has helped me immensely .

Thought I would mention this as it can help make a difference :)

Anna.
 
Recently admitted to hospital for surgery I was horrified upon admission that after having well controlled Type 1 for 40years with no admissions for hypos our hypers I was shocked that old protocol still exists. A nurse asked me to hand over my insulin pens.(Felt what entering prison must be like) I informed her that I had great experience and knew what I was doing. She got v excited when I told her because of travelling to another hospital my blood sugar was slightly raised so I took 3 units to reduce it. She nearly had a coronary. She went away and returned with my insulin pen with a dose of 8 units. I refused to take it as I told if I administered this I’d be dead. A DR on the ward came to see me telling me that she would hand the control over to me. However, the nurses kept my pens and this resulted in me getting my meal but waiting an hour until a DR signed for it. By this stage my blood sugar was 17. This infuriates me when gd control is paramount. I strongly object to this as it made me feel extremely vulnerable. Why in this day and age is this archaic protocol still in place . Is there anyone can help change this?
 
Recently admitted to hospital for surgery I was horrified upon admission that after having well controlled Type 1 for 40years with no admissions for hypos our hypers I was shocked that old protocol still exists. A nurse asked me to hand over my insulin pens.(Felt what entering prison must be like) I informed her that I had great experience and knew what I was doing. She got v excited when I told her because of travelling to another hospital my blood sugar was slightly raised so I took 3 units to reduce it. She nearly had a coronary. She went away and returned with my insulin pen with a dose of 8 units. I refused to take it as I told if I administered this I’d be dead. A DR on the ward came to see me telling me that she would hand the control over to me. However, the nurses kept my pens and this resulted in me getting my meal but waiting an hour until a DR signed for it. By this stage my blood sugar was 17. This infuriates me when gd control is paramount. I strongly object to this as it made me feel extremely vulnerable. Why in this day and age is this archaic protocol still in place . Is there anyone can help change this?
It is a shame that you were treated this poorly. It seems that the best thing to do would be to contact your diabetes consultant before any planned surgery to ask for a letter to state that you must be allowed to manage your own insulin. However, there may still be a battle with individual nurses.
Last time when I was taken in by an ambulance, and admitted to a ward, the nurses insisted on taking away the antibiotics that I had been prescribed for a tooth abscess. They could not remove my insulin pump but only gave me the antibiotics during the ward medical round, which messed up the six-hourly antibiotics. Often there are care assistants rather than nurses on the wards, but even the nurse in charge may not be very bright.
The hospital I was at is in Hampshire, and I have no idea if this is a nation-wide disregard for diabetics' rights.
 
Hello, thank you for passing this on to me. I’m sorry your experience was not good. It’s helpful to hear others stories. I hope you are feeling better.
 
It is a shame that you were treated this poorly. It seems that the best thing to do would be to contact your diabetes consultant before any planned surgery to ask for a letter to state that you must be allowed to manage your own insulin. However, there may still be a battle with individual nurses.
Last time when I was taken in by an ambulance, and admitted to a ward, the nurses insisted on taking away the antibiotics that I had been prescribed for a tooth abscess. They could not remove my insulin pump but only gave me the antibiotics during the ward medical round, which messed up the six-hourly antibiotics. Often there are care assistants rather than nurses on the wards, but even the nurse in charge may not be very bright.
The hospital I was at is in Hampshire, and I have no idea if this is a nation-wide disregard for diabetics' rights.
Out of interest what would happen if you refused to hand over existing medications?

Assuming a person was well enough to administer them what legal right do they have to take those medications away from the patient?

obviously it makes sense to tell them what medications you are self administering and why but I’d be loathe to hand them over or stop taking them unless given good reason by a dr familiar with those medications and conditions.
 
Recently admitted to hospital for surgery I was horrified upon admission that after having well controlled Type 1 for 40years with no admissions for hypos our hypers I was shocked that old protocol still exists. A nurse asked me to hand over my insulin pens.(Felt what entering prison must be like) I informed her that I had great experience and knew what I was doing. She got v excited when I told her because of travelling to another hospital my blood sugar was slightly raised so I took 3 units to reduce it. She nearly had a coronary. She went away and returned with my insulin pen with a dose of 8 units. I refused to take it as I told if I administered this I’d be dead. A DR on the ward came to see me telling me that she would hand the control over to me. However, the nurses kept my pens and this resulted in me getting my meal but waiting an hour until a DR signed for it. By this stage my blood sugar was 17. This infuriates me when gd control is paramount. I strongly object to this as it made me feel extremely vulnerable. Why in this day and age is this archaic protocol still in place . Is there anyone can help change this?
I was in A&E a couple of months back.
Suspected internal injuries & gearing up after 10 hours to keep me in? I was literally watching the confiscation coming from one nurse.
A new nurse was just starting her shift which seemed more tuned in with no patronising. I was willing to communicate every dose & every carb.

The only issue was, I wasn’t planning on being in so long & didn’t have my basal. :banghead:

Whilst discussing this with my accompanying wife on the logistics..

Thankfully, they discharged me..

But I have seen insulin taken off patients whilst visiting my dad a few years earlier..
 
Out of interest what would happen if you refused to hand over existing medications?

Assuming a person was well enough to administer them what legal right do they have to take those medications away from the patient?

obviously it makes sense to tell them what medications you are self administering and why but I’d be loathe to hand them over or stop taking them unless given good reason by a dr familiar with those medications and conditions.
The problem is that when not well, and wearing a hospital gown, I felt too vulnerable to test what would happen if I had refused. Fortunately my excellent diabetes team is based at the same hospital. After my endocrine consultant had been to see me the following day, the staff treated me with more respect. However, the overall feeling I was left with is to try to avoid being an in-patient at all cost.
 
I have to admit @ElenaP , my 10 hour A&E experience with 2 cannulas banged into my arms & all the sticky chest monitoring tabs attached.
It felt like the old “carry on matron” scenario when it was realised I was T1. Then the focus was “an how are your blood sugars?? Hmmmm???”

“Ah well…” as I tried not to laugh like Sid James. “I got an app for that..” (which was only 0.2mmol out from the nurse’s meter.) :p
 
The problem is that when not well, and wearing a hospital gown, I felt too vulnerable to test what would happen if I had refused. Fortunately my excellent diabetes team is based at the same hospital. After my endocrine consultant had been to see me the following day, the staff treated me with more respect. However, the overall feeling I was left with is to try to avoid being an in-patient at all cost.
I understand. All part of feeling well enough to resist and demand better treatment. It’s not always possible. Even I, as a very self advocating person usually, can fold under the pressures in such circumstances. Harder still for those that don’t find it easy to speak up generally. That is why hospitals should have better systems in place to protect us all.
 
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I so agree, HSSS - it's hard to stand up for oneself when one is ill and frightened.

If anyone were to write an "inpatient survival guide" it should include never handing over one's usual medication - or to assuage the protocol, only a small amount of it - as it is then destroyed and one risks being given something worse. My GP had to phone me at home the night I was discharged last time to tell me not to take any more of the meds I'd been given right then as they posed a high risk. Also I was given somebody else's meds on one occasion and treated like a small child when I queried it. Don't hand over hearing aids either. I'm sure others can add to this.

Back to insulin users - I am horrified that this is taken out of patients' control as well. And I know one insulin user who was told he was using the "wrong" injection methods - to which he replied that he'd been injecting since well before the nurse was born.

Don't start me on diet.......
 
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