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need help hospital doc messed up

S

serredethswife

Newbie
Messages
2
Type of diabetes
Family member
Treatment type
Insulin
So this all started monday. My Hubby got a tummy bug that left him unable to eat or drink. His doctor had put him on lantus in April of 14 with no info on what to do if he did get ill enough to not be able to eat or drink so we skipped the lantus.

Sometime After i left for work he went into kda and to the er.From here it gets worse they admit him but are only treating the dka while whatever made him so sick is untreated hes be talked down to and they are acting like this was done to inconvice them any and all questions went unanswered.

The finally give him Lantus at 11:15 am 1/14 next dose at 11:15 pm 1/15 with a gap of 12 hours between the 24 hours that that dose of lantus cover since then his blood sugars been on the rise from 170 at release to 300 tonight at 7 hes checking it after wake up. he was at 64 kilos at admitince i'm learning we are woefully uninformed as we read everything they sent home but its been six years of walking through the dark any advice ill take in a heartbeat as this has reached the point of scary bad
 
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.
 
Hi,

Unfortunaly. Skipping the Lantus is where it went wrong. The lantus works by covering the background blood sugar levels. During an illness such as stomach bugs or flu these blood sugars can still rise.. Even if appetite is lost.?
I recently had flu which unusually knocked me out for a few days over chrismas. My appetite had totaly gone. I could only drink fluid. But my fasting sugar levels still rose. In my case I upped the lantus dose by 2units while I convalesced... i tested my blood regularly & even had to give a small bolus amount on one occasion in order to keep control.. I find personally good blood sugar control is key to faster recovery from any illness....

I can understand why the hospital felt that the DKA treatment was priority... ;)
 
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He has been told he's a type two but no test was done to tell what type we are in the us but I've heard diebetes care is better in other nations. My trust in local doctors is gone the info we have from doctors is cut carbs count carbs and small meals. The center for eduction is woefully neglectful on info give and mostly nurses with little to no training. Same with the hospital ever question I asked was treated like I was crazy for asking and ignored or they just walked away . My hubby's seeing a family doctor there's maybe three doctors in town the know anything about this and they are not taking new people.
We were not told it's okay to give lantus when he couldn't eat or drink . The person who took him to er told them he constantly skips his meds so the tummy bug went untreated so he's still fighting it off I'm just looking for more info on how to help him and to keep him healthy or how to handle doctors and what question we need to ask and how to ask them as they seem crazy
 
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.
 
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