October 15, 2012

Hospitals Will Destroy Your Diabetes Management

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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