October 3, 2013

Improving Type 2 in the Hospital

The more I read about diabetes management in hospitals the less I like the idea of having to utilize them. Some hospitals are better than others are, but all are inept in handling diabetes and maintaining management for diabetes patients. No, I did not make an exception – all are in one form or another inept.

The largest fault I find is the doctors and nurses do not attempt to find out from the patient what the insulin to carbohydrate ratio is that is used by the patient. This is a critical error and probably what drives policies of letting blood glucose levels stay in the 180 to 200 mg/dl. They generally do better for type 1 patients, but not for type 2 patients. I become so belligerent about managing my own diabetes that I am normally allowed to decide my own dosage based on the number of grams of carbs I consume after the fact instead of giving the injection before I eat or even see the food.

One time, I knew that I was not feeling like eating and was told that the carbohydrates for my meal was going to be 65 grams. I refused the short acting insulin until after I saw the food and knew I would only be eating about 15 grams of carbs from the tray. When the nurse started to give me the injection, I refused, as I could not see how many units of insulin were to be injected, and I was worried that I would have an episode of hypoglycemia. When I explained this to the nurse, she said that what she had would be injected and if I did not eat what was on my tray, I deserved hypoglycemia. And, I am to trust these people?

Yes, I called my doctor and the hospitalist and both were there shortly. After my explanation and the nurse's excuses, I was no longer hungry and said I did not feel like eating. My doctor was able to talk to me a little longer and supervised the removal of the tray of uneaten food. Just as he was ready to leave, back came the nurse with the syringe to give me an insulin injection. When the doctor examined the syringe, he laughed and told me to take it. After the nurse left, he said I know you calculate your dosage per grams of carbohydrates, but the nurse calculated it based on carb units so you should end up with a blood glucose level of about 120 gm/dl. After his office closed he came back to see me and measured my blood glucose and the reading was 116 mg/dl.

He in turn, called the head nurse and explained what had happened and that I was to tell the nurses what to inject. If they could not or insisted on their own calculations, I was to call him and then he would call the hospital administrator and the issue would be settled by the removal of a nurse if this would be required. The head nurse said she had complete faith in her nurses to calculate to correct amount of insulin so the doctor called the hospital administrated then.

The head nurse continued to back her nurses and the doctor and administrator put up a sign that I would calculate my insulin dose and they were to let me inject it. Instead of allowing me to submit my meal requests, the nurses took over this and every meal for the next day was about 80 grams of carbs or about 5 1/3 carb units. I still could not eat that many carbohydrates and refused. I was told that I needed so many units of insulin and the nurses would not bring any unless they agreed with me. The doctor said I was be discharged the following morning and to adjust as soon as I could. He was there early to get me discharged and once clear of the hospital, I took my blood glucose reading, which was 231 mg/dl. I injected my Novolog to my scale and drove home. Four hours later, I was back to where I wanted to be at 95 mg/dl and back on my schedule.

This leaves one more operation to undergo and I am still not sure where I will allow it to take place. I will be conferring with three doctors before I make up my mind and probably will be calling the new to me hospitals to find out what their procedures of diabetes management will permit and their guidelines are.

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