July 19, 2010

Hospitalization concerns for persons with diabetes

This is a complex problem. Each state can have rules of conduct for the hospitals and even each hospital can have rules more stringent than the state's rules.

Many hospitals are very friendly for people with diabetes; however, unless you have time to talk to the administrator, and even then, never take anything for granted. I mean this, never take anything at face value. Check, recheck, and then check again. This will make sure the hospital knows that you are concerned and will need to be treated with respect. Some hospitals are also very unfriendly to people with diabetes.

I will emphasize this repeatedly because of the importance. A limited medical power of attorney is more important today with all the privacy rules and regulations in place. People that you want to be able to act on your behalf are often not able to because the hospital does not know them and without a limited medical power of attorney, it is useless to think that they will, even if it is your spouse. So if you are a person with diabetes, carefully consider the value of a limited medical power of attorney for your spouse and/or if you are single, a person or other family member you can implicitly trust.

In any hospital setting, make sure that if you are on an insulin pump that once the procedure is completed and you are recovering that you are allowed to regain control and use of it. But be prepared for those that will not allow you to have or use it.

A check list for hospital care:
1. Entering the hospital with prior knowledge and under doctor ordered request.
  • First discuss the situation with your doctor so that together you can plan the course of action you can have control over. Parts of the plan may be out of your control. Your doctor can often make things go smoothly and you should give them a current list of medications.
  • For what can be in your control, make sure the doctor can make the staff aware that you are a person with diabetes and request you be allowed to take your medications and do the testing.
  • Depending on circumstances, try to be in charge of your own diabetes in the hospital as much as you are able.
  • Again attempt to avoid having hospital nurses be the ones to check your numbers and decide how much insulin or medications you should take.
  • When you enter the hospital, make sure you can take your supplies in a pouch or other secure container. Also take a notebook to keep all the details written down so that you are able to discuss these things with your doctor.
  • If you are unable to do your own testing, secure permission to have a relative preform this.
2. Entering the hospital under emergency conditions.

  • In this situation, you may have to rely on the hospital staff.
  • Be prepared to communicate (if you are able) to the doctor on duty and/or ask for someone in administration to contact your doctor. Or if you have a travel partner, have them do this if you are unable.
  • Do you have anyone that has a limited medical power of attorney that needs to be contacted. This is why you need this information in your wallet or purse.
  • This is also when a medical alert tag is important.
3. Entering the hospital against your will or knowledge.

  • This can be very confusing, because it can be an emergency or you are having a hypoglycemic episode and are arrested and taken to the hospital, and this can depend on many factors.
  • You can only hope that you get the right treatment and this should is one reason to wear a medic-alert bracelet or necklace.
  • Again, do you have a person with a limited medical power of attorney that needs to be contacted?
4. Entering the hospital in another community.

  • Often this will be in an emergency situation and you may not have any control over your treatment.
  • As soon as you are able, make sure you doctor is notified.
  • The limited medical power of attorney thing again.
Procedures can vary with many hospitals. In some, it is highly advisable when possible to notify your doctor and make sure that he is involved as they will not or may not allow you to have your medications in your possession and may absolutely not allow you to medicate yourself.

This can be very important for people with diabetes and your doctor will have to clear this and even then sometimes your medications will still be taken away upon entry or at a shift change. So double check that it is made part of your records if possible before admission. If in emergency, then make sure your doctor is somehow notified.

Also make sure before hand (if possible) of the meals you will receive and be prepared to ask for exact carb count and still be prepared to not eat some foods that will send your blood glucose into the stratosphere. Many hospitals have not learned about high fructose corn syrup and low carb or may not even have a dietitian on staff that knows anything about diabetes. Do not rely on many hospitals having a knowledgeable CDE (certified diabetes educator) on staff.

If you are admitted to the hospital through the emergency room, then everything can go haywire and you may not even have your medications or diabetes supplies with you. This is why you should also keep a list of current medications in your wallet or purse. If possible and allowable, have someone bring your medications to you as soon as you can notify them, but they must know that they are not to surrender them. Better for them to return them to your home than lose them to the hospital. Your medications while in the hospital will cost quadruple or often more per pill than if you have them available to you from your supply. I repeat that some hospitals will not allow you to use your own medications or even medicate yourself.

Also as soon as you are able, let your doctor know so that he/she will be able to smooth the way for you to use your own medications. Depending on the hospital rules and some nurses, you may be forced to hide your medications as they will take them from you, not give you a receipt, and in some instances actually dispose of them.

I'm not saying this to take anything away from how well the nurses do their job, but they can be very busy and sometimes they forget to do things that are important, so keep this in mind.

The following are some links to add to what I have written and first one covers some tips that are also important.
Limited medical power of attorney – disclosure statement. While this example is for the state of Texas, some of the principals apply to any medical power of attorney. Any medical power of attorney should be well spelled out and the necessary limits carefully spelled out. Just be careful of the attorneys that want to draw up a durable medical power of attorney.

While there are forms online that are state specific, I am not sure that some of the limited medical power of attorneys can be made to fit. One limit that should be spelled out is that when you are able to resume charge of your care, that the limited power of attorney is mute and not in force again until you again become unable to manage your health.

1 comment:

Bennet said...

Great points Bob and very true for T1 also.

Our son was admitted for an emergency appendectomy. We did our best to find out how they planned to manage his blood while under. They kept coming back with, "We use a sliding scale." A sliding scale of what?

Post op they wanted to take him off his pump and use theirs. This would have also meant changing from his 'log to their regular insulin.

The kid had enough going on. (He didn't react well to the pain meds. Lots of vomiting) He didn't need his insulin program turned upside down too.

We declined their blood sugar care. Repeatedly and finally in writing. The post op Doc was a little put out. Two days later she commented that Connor had the best managed blood sugar she has seen on the ward.

She was a good doc. A professional. We manage diabetes for living. Specifically to keep our son and daughter living.

You advice to prepare for hospitalization is sage advice.