Urgent help with Mother in law and hospital?

[KnittingGirl]

Hi. Looking for some advice for my mother in law. She is currently in hospital after 3 falls and has a broken collar bone. she is type one and has been for 57 years. The ward she is in has removed all her control over her insulin and blood glucose mon much to my mil horror. She normal injects herself to how many carbs she has had for her meal and what her blood sugar is. However in hospital they are given her the same dosage each time. Her blood sugars are all over the place. One minute she is 24 , couple of hours later it’s dropped to 1.2. Last thursday when we visited her blood sugar was 21 at lunchtime. Her dinner was in front of her but she was refusing to eat till she had had some insulin. I asked how much she had had at breakfast to try and work out why it was high having had just a piece of toast. Turns out her sugar was 7 at breakfast so the dr decided NOT to give her her morning insulin. So I suggested an extra unit at lunch to help bring it back down. She normally had 3 units. They gave her 8. Apparently the dr said to give her her breakfast and lunchtime injections in one go! I ’m, also type one and when I heard this i went through the roof with them. Tonight however she has just rung to say her sugar is 6. They have given her no carbs for tea yet want to give her 6 units. I argued with the nurse on the phone saying that 6 will probably send her into a diabetic coma and to only give her 2? The reply was that she either had 6 as the dr recommended or none? They won’t discharge her from hospital because her sugars are not under control? I am debating whether to discharge her myself? Anyone been through this?

 

[Paul_]

I'm T2, so wouldn't know where to start with advice, but just wanted to offer some words of support nonetheless. Many of us diabetics, regardless of type, have unfortunately had challenges when dealing with medical professionals. I'm sure some of the T1s on here, or family members of T1s, might have faced similar challenges and can hopefully offer some advice. All I can add from my personal experience is to trust your instincts and fight for what you know to be in your/their best interests.

Hope everything works out and you manage to get better care for your family member.

 

[Antje77]

she is type one and has been for 57 years. The ward she is in has removed all her control over her insulin and blood glucose mon much to my mil horror. She normal injects herself to how many carbs she has had for her meal and what her blood sugar is. However in hospital they are given her the same dosage each time.

From this I'm understanding that your MIL is perfectly capable of handling her diabetes herself, broken collarbone or not.
But I'm not completely sure because you also seem to be suggesting dosage changes, is this because they won't listen to your MIL or because she needs the help?

So I suggested an extra unit at lunch to help bring it back down.

If she's able to manage herself, and is willing to do so, the NHS guidelines are very clear on this:
The guiding principle of this document is that people with diabetes manage their condition on a day to day basis when out of hospital and should continue to self-manage during a hospital admission unless there is a specific reason why they cannot.

Short article on the matter here: https://www.diabetes.org.uk/profess...tions/self-management-of-diabetes-in-hospital, full guidelines here: https://diabetes-resources-producti...-08/JBDS self management updated Aug 2021.pdf

 

[EllieM]

Hi @KnittingGirl and I am sorry your mother is in this position.

My T1 mother had a similar experience in a UK hospital in 2012, age 77, when recovering from multiple organ failure in intensive care. She genuinely didn't feel well enough to inject, but the nurses were only allowed to give her what the doctor prescribed, Unfortunately as she recovered her insulin needs went down dramatically and she was starting to hypo. It was the weekend so the diabetic specialist wasn't around. They compromised by saying that she could refuse to have her bolus or basal, so she lasted on basal alone till the doctor looked in a day later, apologised profusely, and told the nurses to give her whatever insulin she asked for.

I am bewildered because in all my experiences of UK hospitals (broken leg, appendix, two babies) the hospital let me handle my own insulin. Admittedly that was all last century so maybe the rules have changed . But I wonder if your mother is being treated differently because of age and (perceived?) mental incompetence???

Something doesn't seem right here.

 

[Olddogandgrump]

That is an absolute outrage. There is no way on earth they should be taking control of your MIL's diabetes like that unless she hasn't mental capicity, which by the sounds of it is not the case. And even if that is the case, they are making a pig's ear if it.

From my experience, hospitals are pants at controlling diabetics' blood sugar. My mother (T1, 50 years) was admitted earlier this year for non diabetes reasons. She was suffering from dementia and my Dad had been managing her insulin at home. They lost control of her blood sugar as soon as she was admitted and stopped my Dad's efforts to monitor and control.

No one knows how to balance carbs and insulin like the patient themselves. I would be kicking up a fuss to either have control returned to your MIL or a diabetes specialist if the hospital insist on them keeping control. But a complaint would certainly be in order. Prescribing six units to someone at 6 mmol/l after a carb free meal is madness and should be investigated.

 

[Jaylee]

I empathise with you..

Many years ago my T2 dad was in hospital for something unrelated. There was an insulin dependant guy in the bed next to him had his stuff confiscated by a nurse. As I visited. They also thought my dad’s high BGs were “good.” (Hello?. T1 handy with a meter here.)

I was in A&E a couple of months back with 3 busted ribs they suspected internal injuries which wasn’t the case?
They were prepping up to keep me in.( I was signing green forms?)I’m 55 years old & found myself treated like a dolt…
I carried my meter & had a sensor. But that didn’t matter grabbed & tested. (Before any consent. Which would have been given, anyway..) Ironically the NHS meter was bang on with my sensor as she held her meter in my face like I was blind. (Within 0.2 mmol.)

To be fair, the next nurse taking over the shift was cool… after understanding I’d been undergoing tests for nearly 10 hours. She was up for letting me charge my phone for my sensor..

I would fight tooth & nail to manage my diabetes, but with clear communication with HCPs regarding what I have done…

 

[daffy1]

Sorry for the problems you’re having. I’m T2 but find very few professionals fully understand that diabetes affects each and everyone differently . When I had to see a dietician she kept insisting I had porridge with double cream on a morning. I told her that oats send my BG the roof but was told no they come down in a couple of hours. No they don’t not for me. It can take till 4 pm with nothing to eat before they get below 10. Carrots apples beetroot all do the same yet I can eat potatoes and rice. We know our bodies much better than the so called professionals. The only one that I’ve spoken to had any real understanding was also a diabetic

 

[AndBreathe]

Hi. Looking for some advice for my mother in law. She is currently in hospital after 3 falls and has a broken collar bone. she is type one and has been for 57 years. The ward she is in has removed all her control over her insulin and blood glucose mon much to my mil horror. She normal injects herself to how many carbs she has had for her meal and what her blood sugar is. However in hospital they are given her the same dosage each time. Her blood sugars are all over the place. One minute she is 24 , couple of hours later it’s dropped to 1.2. Last thursday when we visited her blood sugar was 21 at lunchtime. Her dinner was in front of her but she was refusing to eat till she had had some insulin. I asked how much she had had at breakfast to try and work out why it was high having had just a piece of toast. Turns out her sugar was 7 at breakfast so the dr decided NOT to give her her morning insulin. So I suggested an extra unit at lunch to help bring it back down. She normally had 3 units. They gave her 8. Apparently the dr said to give her her breakfast and lunchtime injections in one go! I ’m, also type one and when I heard this i went through the roof with them. Tonight however she has just rung to say her sugar is 6. They have given her no carbs for tea yet want to give her 6 units. I argued with the nurse on the phone saying that 6 will probably send her into a diabetic coma and to only give her 2? The reply was that she either had 6 as the dr recommended or none? They won’t discharge her from hospital because her sugars are not under control? I am debating whether to discharge her myself? Anyone been through this?

KnittingGirl, at worst your MiL should be seen by the hospital Diabetes Team. If that hasn't happened she should request it, firmly.

If the staff aren't helpful, could she call the clinic she normally visits for her routine care and ask for their assistance?

Unfortunately, it is highly unlikely there will be a member of staff on the ward familiar and competent in T1 care. In that circumstance, they would rather maintain blood glucose a bit higher to prevent medically dangerous hypos, but by your description that isn't quite being met either.

Logic is it, generally takes longer for high glucose to do any lasting damage than a critially low low, which can be dire or worse, very quickly.

I do hope things improve quickly for your MiL.

 

[Grant_Vicat]

PALS immediately springs to mind. Lodge a firm but polite complaint and things should alter pretty quickly.

 

[Daibell]

I would insist that she is allowed to manage her own insulin and testing. If she is otherwise fit to be discharged it would be safer for you to discharge her rather than risk a serious hypo the way she is being managed

 

[EllieM]

I'm also wondering what sort of hospital meal she had that had 0 carbs, normally they are loaded with them?

 

[Nicola M]

I would definitely insist she should control her own medication and possibly ask them if she ca see a diabetic nurse/doctor.

I distinctly remember one time when I was in hospital I was on a sliding scale, I was alert and didn’t need to be as I was capable of doing my own insulin but they insisted I be on a sliding scale. They told me if my blood sugars were stable I could come off of it and go home, the insulin ran out and it took a nurse 2-3 hours to refill it. My sister who visited at the time was furious as my blood sugar rose in that time and they wouldn’t take me off the sliding scale because my sugars had gone back up. We both continuously asked them to refill the insulin but they just did not seem bothered.