This blog got its start quite by
accident and not one putting anyone or me in the hospital this time.
In discussing patient centered care with David Mendosa, I rather
exploded about hospital care. David, in his calm and collected way
asked if I had read any of Dr. Bernstein and I had to admit I have
not. David said he would provide me with a link to his blog about a
letter to get signed when entering the hospital. After reading this,
I may have to get up the courage to read Dr. Bernstein’s book.
Unless there is something that I am researching, I seldom take time
to read a book for the pleasure of reading. Since I do a lot of
research about type 2 diabetes, I am not reading much published on
the type 1 side of the spectrum. No one to blame but myself.
Back to hospitals and why they are on
my list of “avoid if at all possible”. It is understandable that
hospitals and doctors have an aversion to lawsuits and this drives
many of the healthcare decisions they make. People with diabetes is
one group that pays dearly for this aversion. Hypoglycemia is the
fear that draws attention and dictates much of the policy for care
when person with diabetes is hospitalized. The term that is used for
most healthcare is defensive medicine. For patients with diabetes,
this means allowing blood glucose levels to be maintained at levels
that slow healing and can lead to increasing the risk for
complications to develop. Thus the hospitals are caught in conundrum
for care. The chance of hypoglycemia depends on the medication and
if the patient is on insulin or sulfonylureas the hospitals use a
level of blood glucose that will generally avoid hypoglycemia and is
in the hyperglycemia range. Most, but not all, hospitals want the
lower limit of blood glucose to be 180 mg/dl (10.0 mmol/l) or
slightly higher. The longer your blood glucose levels remain at this
level, the more you are at risk for complications. Because of the
smaller likelihood of you developing complications while under
hospital care, this is the goal of most hospitals.
Another area that patients with
diabetes need to be concerned about is diet while in the hospital.
Forget that you have diabetes and please do yourself a favor and do
not request the diabetic menu. Because the dietitians for the
hospital follow the American Diabetes Association in diet planning,
the menu is high in carbohydrates and low in fat. This creates all
sorts of problems for patients with diabetes. Those on oral
medications will have extra problems because of lack of movement or
any type of exercise. Those on insulin (which most that are
hospitalized are converted to at least while hospitalized) will run
blood glucose levels of 180 mg/dl or higher. The one procedure I
will commend hospitals for is giving rapid or short acting insulin
after meals so that if the patient does not or is not able to eat a
meal, hypoglycemia is averted by not giving an insulin shot.
If you are scheduled for an operation
or admitted to the hospital in an emergency situation, please be
aware of the above problems and consider the letter in David
Mendosa's blog. Even if it is an emergency admittance, if a family
member or a close friend can advocate for you and have the letter
presented, this may help. A reminder, you may have to stand your
ground as most hospitals will refuse to allow you, the patient, to
treat yourself for diabetes because they do not want the liability of
something going wrong. I dislike saying this, but you are are higher
risk of surgery complications and even death if the hospital keeps
you on their diabetes regimen. Studies have shown this to be true
and as a patient you need to be aware that this can happen.
I have a friend that lost about $300
because a nurse confiscated his insulin and testing supplies and
destroyed them. Horror stories like this abound and this is because
the hospital medical staff lack the training in diabetes care and
some just don't care. Others do care and if you are mentally capable
of managing your diabetes, they will allow this to happen even
against hospital policy. So do consider the letter in David's blog
and if needed adapt it to fit your needs. You will benefit your
health by managing your diabetes versus letting the hospital manage
it.
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