October 25, 2010

Hospital Awareness for People with Diabetes

Since the this post, more information keeps coming to light that people with diabetes need to be aware of when entering the hospital. There are some nasty situations that can arise even when the hospital is aware that you have diabetes. The nasty problems are life threatening if the hospital is unaware that you have diabetes.

If you are having an IV(intravenous therapy), please make yourself aware of what will be in the IV. You will want to be sure that dextrose or other sugars are not part of the IV. The IV should be saline, but many are five percent dextrose. For people without diabetes no harm will be done. For people with diabetes, this will play havoc with blood glucose levels (BG) management. Depending on how many you will be given, it could raise your BG to levels higher than manageable immediately, even with insulin, and will require close management for at least 24 hours or more.

So it does not matter whether you are Type 1 or Type 2, be careful of what you are given in your IV's. To assist in maintaining your independence and preventing the inadvertent problems, you should ask your doctor and the hospital administration for release forms to allow you to medicate yourself and to maintain control of your diabetes management. Drives hospitals crazy, but protects them as well as you.

Another area of concern, if you are having any surgeries, will be the medications you will be given (if any), and how they will react with BG levels. There are many medications that can raise BG and you should talk to the surgeons or physicians about your concerns and what medications you may be given.

If enough preparation time, have you doctor find out and discuss the medications you will be given. Be prepared to adjust your insulin needs or oral medications while in the hospital and your doctor can be of great assistance in making adjustments easier to handle. David Mendosa presented the list from Diabetes in Control dot com. This is a very good list to be aware of and use.

If you have surgeries that will involve body part replacements, steroids will probably be involved and this should be known. Steroids will elevate BG levels and for those on insulin, careful watch needs to be done and sometimes extra testing of BG is needed to adjust insulin. Those on oral medications should actually consider using insulin to manage BG levels while on steroids. If staying on oral medications, consult your doctor for dosage and possible addition of other oral medications.

Never be afraid to ask questions and ask for the advice from your doctor or endocrinologist as this assistance may keep you from making some serious mistakes. You may need to schedule another appointment to get this all in, but it will be worth the time and peace of mind for you. If you need to stand your ground, be ready to – it is your health.

This is worth repeating from the previous blog – try to get your medications approved and be prepared to sign any waivers necessary to have them with you. You will still need to guard them carefully. A local legal case brought this home for me. Patient had his medications approved and special warnings put on his chart and records that the medications were to be left with the patient as they were not available in the hospital and patient was allergic to certain comparable medications.

Evening shift nurse thought she knew everything and confiscated his medications and disposed of them in the medical waste. When this was discovered, the patient was suffering from an allergy attack from a substituted medication. When the doctor discovered this and the fact that his medications were gone, at least he had an internal investigation started. Outcome was patient recovered and needed three extra days in hospital at no cost, nurse lost her job, and hospital was out some money in the legal case plus had to replace the destroyed medications.

It is sad that only the bad get the publicity and those that do their jobs do not get the recognition they should. The attitude of the evening shift nurse does happen to be prevalent in more cases than we would like to acknowledge. I am not into speculating what the reasoning for this is; however, hospitals are beginning to slowly realize that with patients who are advocates for themselves, they must listen and facilitate, plus have the nursing staff in full cooperation mode.

The above is all written with the fact that you have knowledge of what is to happen and when. Remember that if you enter the hospital under emergency conditions, then hopefully your spouse, good friend, or other family member can act for you and determine that the above in handled for you. I will mention the limited medical power of attorney again to make sure that those you trust are able to act for you. They must be prepared to act for you and see to your health until you are able to assume that role.

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