need help hospital doc messed up

Hi @serredethswife, welcome to the forum.

I cannot help as I am a Type 2 but will bump your post up for a reply.

catherinecherub said:

Hi @serredethswife, welcome to the forum.

I cannot help as I am a Type 2 but will bump your post up for a reply.

Click to expand...

Catherine - Would this thread be better in one of the T1 forums, to get maximum viewing by the relevant people?

@serredethswife - sounds dreadful. I'm sure you'll find some support here.

I'm sorry to hear of your experience. Hospitals are not always very knowledgeable on the broader aspects of insuln treatment as A&E is overworked and they cover so much. You can't change what happened but obviously any illness needs treatment for that and insulin needs will usually increase (called sickness rules). When I had an operation last year my needs increased and I tested myself more frequently and increased my Basal. Going into DKA is an emergency so best avoided once you understand you have diabetes and how to handle illness and not eating. I guess the top priority is very frequent testing and take some control yourself; never rely just on a hospital managing your diabetes with insulin. When I had my op, which was not an emergency, we agreed I would manage my insulin and we both tested frequently. So, you have learned the hard way due to poor medical support.

Hello and welcome to the forum. This has been a worrying time for you!

As @Jaylee said, your husband needs to continue to take his Lantus injection even if he is not eating, because a tummy bug illness itself causes his blood sugar to rise above normal levels.

While he recovers from his tummy bug he needs to rest and drink plenty of plain water.
When he gets his appetite back, he should follow his doctor's advice to eat smallish meals, reduce carbs, drink water, and test his blood sugar regularly. If he keeps a good record of his blood sugar level, he can work with his doctor to improve things and look after himself.

The ER treated his DKA as a priority because it is dangerous to have very high blood sugar levels.
Getting over a tummy bug takes longer if your blood sugar is too high.

Best wishes and I hope your husband makes a speedy recovery.

Hey there.

Sorry to hear your hubby is not well, hope he is improving.
Let me try and break down a few things from some sick day rules that should translate over to your situation.

• Never stop taking the insulin. Even if you are not eating you still need it
• Make sure to keep your fluid intake up. At least 200ml (~6fl oz) every hour or two.
• Keep monitoring blood sugars and ketones every couple of hours (Be sure to record both in a log)

Now to explain a few of the points above so that you can understand the reasoning for them.
Your body needs insulin to process glucose that is in the body regardless of if you have eaten or not, when you are sick (as a diabetic) you will find that your insulin requirements actually go up, sometimes significantly. My own experience has been that once ketones are detected I need to add some insulin to "cover" the ketones as well as the blood sugar corrections.

The fluid intake is critical, when your BG rises and your body is generating ketones your kidneys will be trying to flush both so you will naturally dehydrate much faster than you would expect. This doesn't really help your body any with just trying to fight off the infection.

Keeping a good lug of blood sugars at all times is useful to help you manage the condition though when you are sick it can be more important since it can show if you are actually getting worse, better or still fighting off the underlying infection. Including the ketone readings (you can get meters or urine dipsticks to test) can also help Dr's to get a bit of history.

One observation / question I do have is why were you giving partial doses of Lantus? That seems to be completely counter to everything I have ever been taught or read about it. What you need to be aware of is that lantus is a slow release insulin so doing really small split doses is going to be of limited help in this situation. If your hubby forgets to take a dose the best thing to do would be to start taking the doses again as soon as possible. If it is several hours later then perhaps you could reduce it a little bit to put you back onto the normal time though I strongly suggest that you try and discuss that with a specialist. As a T1 when I have had to move the timing of my Lantus or Levemir I have typically filled in the gap with my quick acting insulin then continued as normal with the full dose.

I hope your hubby starts to get better soon and you are able to find a Dr or nurse that is actually able to help you get to grips with this.

/A

As mentioned above - if you husband is on Lantus it is likely required as an 'every day thing' especially if he is type 1.

Even when sick you should never totally skip the lantus, there may be a need to lower or increase the doses. In many cases when a T1D gets sick there is a need to up the insulin, its all something that has to be considered on a case by case basis and only after many checks to see where the sugars are trending. However in case of illness, even if one cannot eat or drink you should still inject it, as its likely there just to cover the background insulin that the body constantly needs even when not eating meals.

I would think in this case you should step in and AT LEAST ensure he gets his lantus everyday, roughly 24 hours apart. Doesn't have to be on the nose, but a 12 hour gap is not recommended.

Beyond that, he may just have a stomach bug, which may not need medical attention, however the DKA does, so they would be treating him for that and sending him home.

Hospitals don't always know best, doctors usually do, but after that order gets written down its up to many many other people to follow it while they follow many many other orders, and things can get messed up. I was given MANY full sugar meals when i was in the hospital last... To the point where i had to ask at every meal if it was all sugar free, usually they would say "Oh, no... i will take this back" which didn't fill me with confidence.