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53 Responses

  1. Scott E
    Scott E June 27, 2013 at 6:08 am | | Reply

    This is just so wrong…and sadly, so true. We shouldn’t have to decide which ER to go to based on our doctors’ networks in times of need — and we shouldn’t have to override the wishes of the ER doctors (which I have done) because we know what’s best.

    On a different note, that’s a scary thought: losing the cognitive abilities to operate an insulin pump. It scares me to think that could happen.

    Meanwhile, I’m glad Mom is back home and doing better.

    1. Bruce Miller
      Bruce Miller June 28, 2013 at 3:53 am | | Reply

      Hi Mike,

      Horrible story.
      Sounds like a typical failure of some medical care professionals to fail to grasp D basics.

      I assume these folks in the ER were smart enough NOT to use the standard D5W (5% dextrose IV fluids) for your mom.

      Dr. Bernstein always emphasizes that if we ever are admitted to the hospital that we have a letter prepared in advance that indicates normal saline only and never the standard dextrose IV fluids should be used. I have that on my alert D-tag as well.

    2. Elizabeth
      Elizabeth March 6, 2014 at 11:36 am | | Reply

      This type of story is so common. I consider the ER to be the most dangerous place for me as a type one diabetic. Just last winter, I went in for unrelated issues. My blood sugar was normal upon arrival. The ER doc ignored what I said I needed as well as my outside dr’s orders. She took away ALL my long-acting insulin and gave me no insulin for meals. I got sliding scale only for 1 1/2 days. When I got home my bs was too high for my meter to even read, and I vomited- clearly enterring DKA. I went through a slew of channels of complaint but got no satisfactory response. Even the ADA said their legal system would not help bc I was in a hospital- not prison. Really?! Prisoners deserive help but patients don’t? I honestly am beside myself when I realize medical institutions cannot take care of my medical condition.

  2. Brian (bsc)
    Brian (bsc) June 27, 2013 at 6:18 am | | Reply

    While I often shake my head in disbelief at these sorts of stories, we don’t really know the situation. There may well have been a real medical reason to be very conservative with insulin in your mom’s case. When you have a very serious hypo a T1 who has a harsh low will often counter regulate on their own, dumping glucose from their liver, thereby averting harm. When that doesn’t work, you can give glucagon which causes your liver dumps absolutely all its glycogen as glucose. But then the glycogen is not restored for literally days. Thus in the day or so afterwards you are “compromised.” If your mom had a hypo the next day, she probably wouldn’t counter regulate herself and glucagon would not work and the only way to avert a disaster is immediate administration of IV glucose. So there might be some real medical reason to have taken such a conservative position.

    That being said, part of the issue is also that ER’s treat acute conditions. As far as they are concerned diabetes is a chronic condition. As long as they can get you out of an immediate medical emergency the rest of your health issues are somebody else’s problem. Nobody is going to immediately die from some blood sugars in the 400s.

    1. Natalie ._c-
      Natalie ._c- June 28, 2013 at 10:01 am | | Reply

      They won’t die from a BG in the 400s unless they are in DKA. Ref. my post about my experience — my friends told me that if they hadn’t gotten me to the hospital, I would have been dead by morning — my kidneys had failed and my liver enzymes were way wacked out. I’m lucky I have such good friends!

      1. Elizabeth
        Elizabeth March 17, 2014 at 5:26 pm | | Reply

        I once (actually, twice) ended up in DKA while in the hospital for completely unrelated issues. The doctor wanted to give me DOUBLE the amount of insulin I needed. I left AMA because I knew I was going to be on a see-saw of extreme highs and lows until I got home and could do things myself.
        Within 24 hours of leaving, I was fine, having been vomiting with ketones the day before.

  3. Cara
    Cara June 27, 2013 at 6:21 am | | Reply

    One of my greatest fears is hospitalization, just for this reason.

    1. Elizabeth
      Elizabeth March 6, 2014 at 11:38 am | | Reply

      OMG. Me, too :( !! Some hospitals apparently have not a single endo on staff.

  4. Mary Dexter
    Mary Dexter June 27, 2013 at 7:26 am | | Reply

    This article popped up in my Facebook feed. It’s obviously also a problem in other countries as well.
    One in three diabetes patients ‘are given the wrong medication while in hospital’
    A third of patients in England and Wales experienced a ‘medication error’ during a five week audit
    The audit found that 61 patients had developed life threatening ketoacidosis during a hospital stay
    Charity Diabetes UK says it is ‘appalling’ that anybody should develop the preventable condition

    By Daily Mail Reporter

    PUBLISHED:19:49 EST, 26 June 2013

    Read more: http://www.dailymail.co.uk/health/article-2349313/One-diabetes-patients-given-wrong-medication-hospital.html#ixzz2XQVFB8B4
    Follow us: @MailOnline on Twitter | DailyMail on Facebook

    1. Mary Dexter
      Mary Dexter June 27, 2013 at 7:41 am | | Reply

      Also, this poster from the ADA conference describes how CDE’s trained interns to titrate insulin doses.
      Using an Educational Intervention to Improve Inpatient Glycemic Control One Intern at a Time

      1. Elizabeth
        Elizabeth March 6, 2014 at 11:43 am | | Reply

        I am not surprised. I ended up in DKA twice last winter while in the hospital for completely unrelated issues. When is something going to be done to change this??!! Obviously having severe highs or lows is not going to help us heal from whatever brings us to the hospital. As well it is can be quite traumatic when, for example, a nurse enters the room with a dose that you know is so much more (or less) than you need. I once filled an entire page with diabetes errors that have been made at my expense while in the hospital. I would love to see someone file a suit over this kind of thing. I am not the vengeful type, but really, it seems nothing is going to change otherwise.

  5. Dan
    Dan June 27, 2013 at 7:37 am | | Reply

    Hi Mike,
    Hope your mom is doing better! I will ask a different question. Did anyone attempt to download the data from her Dexcom unit? Without data, on what basis are they determining a course of action to follow? I have spoken with ER nurses regarding teenagers and hyper episodes. And my question was: Did anyone attempt to ask about a blood glucose meter and read the data? At one time fire trucks were pull with horses. Let’s consider the implementation of better equipment.
    As always have a great day.
    Dan

  6. Janette Emerson
    Janette Emerson June 27, 2013 at 7:38 am | | Reply

    This is really scary. I wish it will never happen again. I can’t imagine if this incident will also happen to my daughter or my dad.

  7. Karen
    Karen June 27, 2013 at 7:40 am | | Reply

    I’m also a Type 1 diabetic and have been for 35 year. I no longer go to the ER for diabetic care due to my own bad experience with a high blood sugar incident and an ER visit. My sugars went up unexpectently into the 400s. We went to the local ER, the triage nurse looked at me and said “what do you expect us to do?” Lower my sugars..duh She sent us home with the directions to “take some insulin”…Another time while I was hospitalized for a surgery my sugars were running in the high 200′s and when I asked for an adjustment the nurse said “Don’t you worry, we like you to run a little sweet.” A little SWEET?!? It’s very frustrating and scary that the quality of type 1 diabetes is so poor in the hospital setting. I’m glad that your mother had strong support with her to help her through this rough patch.

  8. Heidi
    Heidi June 27, 2013 at 9:23 am | | Reply

    That is truly scary. Most of us(that attempt good control)
    probably do so solo..& our family/friends wouldn’t know how to operate an insulin pump, etc.(my husband knows how to give glucagon,not so much the nitty gritty day to day stuff) And hospital staff seems to be a huge fan of either ignoring the D till you get to 500 or putting you on a sliding scale,actual insulin needs ignored. From personal experience I do not trust anyone’s recommendations(unless its my Endo/CDE) when it comes to my diabetes,& I keep a list of basal rates,correction ratio, etc. (& from the other perspective, I’ve never understood why they don’t ask patients whether they are type 1 or 2. It’s rarely in the chart,(well,at least not where I’ve been a student nurse) it’s extremely relevant to the patient’s care. If this is the case elsewhere, no wonder insulin dosing is so optional) Not being able to speak for yourself in an emergency is a frightening thing, & so many D folks out there are receiving substandard care. Everyone with diabetes is different,and nurses in particular have problems grasping the care differences.(IMO) The entire system is flawed.

  9. Stacey D.
    Stacey D. June 27, 2013 at 10:09 am | | Reply

    First of all I hope your mom is doing better. That is a scary situation indeed. Second, your contact mentions that there are many things to consider in treating a serious hypo or hyper situation and I totally agree with that. However I personally feel in a lot of cases of PWD being treated in hospitals that all things are not considered and there is more of a one size fits all treatment plan. They don’t seem to realize how varied each PWD response to treatment can be. I can only hope that things improve for this issue.

  10. Brian
    Brian June 27, 2013 at 10:10 am | | Reply

    In the summer of 2012 i needed to go to the ER because I had gone into DKA (Diabetic Ketoacidosis). The nurse’s first question was “are you diabetic.” Fortunately I was cognizant and my daughter was there to make sure things got done. Unfortunately things didn’t go well with the hospital staff during that visit but we got through it.

    I guess I’m saying that my experiences with the ER aren’t good either. I had another bout with DKA a few months after this one and I called my new Endo as he recommended instead of going to the ER and between the 2 of us we got it taken care of wothout the trip to the hospital.

    I’m all for helping hospitals (not just ERs) provide better care for diabetics and one thing they need to realize is the patient and their family need to be included in providing that care. Afterall, they know the paitent better than the hospital staff.

  11. Lola
    Lola June 27, 2013 at 11:24 am | | Reply

    Sadly this is similar to what I’ve seen happen in the UK hospital system. Nobody seems to know what to do about it, because the obvious path (train the ER doctors in care of T1) doesn’t seem to be possible – I don’t know why not.

  12. Bob Fenton
    Bob Fenton June 27, 2013 at 11:31 am | | Reply

    I don’t think it matters which type of diabetes you have. Even with endocrinologists on staff, most hospitals muck it up and let people become hyperglycemic because they are scared to death of hypoglycemia.

    Thanks for the post Mike and alerting more about the problems PWD face in ER’s.

  13. Mark
    Mark June 27, 2013 at 1:27 pm | | Reply

    Due to an infection and very high fever, I was admitted to the hospital with DKA. Six hours sitting in emergency with no idea what was going on, no insulin, nobody understanding- just a saline IV. Things went downhill from there. After I was admitted, there was still no insulin and the Great Insulin War began. They weren’t willing to give me any more than their sliding scale permitted (which didn’t go into the 500′s), no long-acting insulin and no consideration for the carbs in the meals. To make a long story short- I had to get into a massive battle to get my insulin brought from home after I threatened to leave. And this with my Endo right across the street from the hospital! I was immediately put on a “diabetic diet” which meant practically no nutrition whatsoever. When I questioned the amount of carbs in something they brought, it was snatched away with the comment “you shouldn’t be having that”. I was in for ten days and lost over 20 lbs in this ordeal that I never, ever want to repeat again. It’s shocking how little they know- or care- about type 1 and how to treat it. And this is just the tip of the iceberg to this hospital story……..

  14. God
    God June 27, 2013 at 1:31 pm | | Reply

    I know both Medtronic and Edwards LifeSciences have hospital CGM’s in Europe. I think they are more for intesive care units. I don’t know much about them, but I think they are having challenges gaining traction. I do know that Edwards has said this is a pivotal year for the US/FDA pathway.

    Even without those hospital CGMs, the foundation of education and processes just aren’t in place and would go a long way.

    The real solution is to avoid the ER in the first place, which obviously isn’t always easy, but thanks to technology it is much easier. In your mom’s case, accidentally giving a relatively massive bolus while sleeping, I am sure, is extremely rare. All I know is if I end up in the ER and am conscious, I will fight them if they try to touch my pump and CGM.

    How accurate was the Dexcom at the time and what kind of pump was it?

  15. Mike Ratrie
    Mike Ratrie June 27, 2013 at 1:47 pm | | Reply

    Mike,

    Let’s start with WOW (and not in a good way)!!!!

    My anecdotal experiences with both D and non-D is every patient needs to have a “project manager” that is NOT affiliated with the hospital, but is charged with keeping the patient’s health paramount. Contradictory, yes, but seemingly all too necessary these days.

    In my experiences (again, anecdotal) someone in the family has to start asking very pointed questions and not be satisfied with “answers” that seem illogical. There’s a lot going on in an ER and sometimes you have to be the squeaky wheel …

    Your mom’s story raises a ton of questions.

    Was the pump removed? If so, why? I ask because once a pump-using PWD is back in “range”, it seems logical to return to the normal therapy that has worked quite well.

    Where was her D-Team between the Hypo ER trip and the Hyper ER trip? IOW, why not go to the hospital affiliated with her D-Team on the return trip?

    As an aside, under the ACA (in 2014?) the hospital could be penalized for re-admittance, so this is another reason why they might have been “more concerned” when she was re-admitted.

    Did the insulin IV drip that got her into the 200s end @ midnight? Did you or your mom say anything?

    Etc, etc.

  16. Gina L.
    Gina L. June 27, 2013 at 3:00 pm | | Reply

    I have been a type 1 diabetic for almost 25 years, and was raised by a mother who suffered with the same for 51 yrs. I was recently hospitalized for four days, in a CCU, for orthostatic hypotension, in a brand new, high tech, hospital in NJ. In the ER, my sugar was 415 (b/c I had missed two doses of insulin by the time I got there (dr office first). My “RN” actually told me & hubby that they were going to get me “a lunch tray to see if the sugar goes down on its own”. My husband questions her & informs her that my sugar will go up if I eat without getting insulin, and she tells him that we–he & I–have been misinformed. WTH??? After admission, several more horrific situations occurred. I cannot tell you how many nurses were literally shocked that I gave myself my own insulin injections (after 25 yrs???? who the hell else is gonna do it??? I AM THE DIABETIC). I called the dietary dept twice after ordering sugar free ice cream and receiving regular ice cream, and TWICE, I was told (by two different ppl) that the sugar free had more fat calories than the regular, and cardiac patients couldn’t have the high fat calories. (FOR REAL?!!?) The last treasure I will share with you is that one night, about 3:30am, I called the nurse after awakening in a sweat & checking my sugar. My BS was 30. I told her what it was, and told her I needed sugar. She –an RN– brought me a half of a cheese on wheat sandwich. I told her, again, my sugar was 30 and I needed sugar sugar sugar. Bring me a juice, any juice–to which she replied that I was a diabetic and diabetics should not have juice. DEAR GOD, HELP ME!! She finally left the room and found me one pack of graham crackers (two cookies) and a container of apple juice. She had to go to another floor to find them for me.

    In the past 25 years, I have only been to the ER twice, leaving both times as soon as I was physically able to do so, and only hospitalized once for my diabetes, and that was back in 1991. It is a scary, scary place to be, especially because you HAVE to go there. If I am not dead, or very close to it, I avoid the ER! And that is a shame–not just for me, but for other diabetics.

    Want to know the worst part, for me, anyways? I am an RN…a long time nurse. The care I have received is not only disappointing, but it is embarrassing to my profession (a profession that I love) and the entire health care organization. Something HAS to change.

    Best wishes to you and your mother. And, thank you for your article. Take care…G

  17. Bernard Farrell
    Bernard Farrell June 27, 2013 at 3:02 pm | | Reply

    Mike, I’m happy to hear your mum made it through this terrible ordeal. It sounds like a visit to the management of that hospital might be useful. At least send them a link to this post.

    I’ve had three, non-emergency, hospital visits this year here in Massachusetts. In all three cases, the 2 hospitals involved said that I was in charge and they’d only ask me for BG readings during the day. I was pleasantly surprised at this enlightened approach.

  18. Joe
    Joe June 27, 2013 at 4:33 pm | | Reply

    I am sorry that happened to your Mom. Hospitals and ER’s are not equipped or properly trained to deal with Diabetic people in my opinion.

    I’m a T2, and when I had my left knee replaced in 2008, the hospital did not listen to my diabetic meds needs. I was on and still on Humalog 75/25 mix plus at that time Byetta. They gave me regular insulin, no Byetta, no metformin, and would ask me why my blood sugars were high.
    I flat out told them why and they just shook their heads. If I ever need to have surgery of any type again, I’m bringing my own meds.

  19. Jim Paige
    Jim Paige June 27, 2013 at 6:34 pm | | Reply

    Why not highlight the names of the hospital, doctores & nurses.

    Complaining about problems without disclosing exactly what hospital is screwing up is virtually useless.

    The only way to get real change is to get some backbone & use the web to out these incompetent people.

  20. Caroline Yeager, M.D.
    Caroline Yeager, M.D. June 27, 2013 at 10:05 pm | | Reply

    I am a doctor, retired, and have T2DM. Do doctors know about diabetes? No, not unless they have it. Are they taught about it in medical school? Only in a cumbersome and overly intellectual way.

    When you think about CPR and how even the Janitor is trained in it, the same simple, basic approach can be done with DM. Both my husband and my BFF know what to do if I get hypo, and it’s simple. [ If I get a low meter reading or feel hypo, I tell my husband, or in his absence, call my BFF, who is nearby. Then, I take glucose, and 15 minutes later, a smoothing meal. If I had to call my BFF, she knows to call me back in 15m, and if I am goofy or don't answer, to come over right away.]

    Another catch is patients with thyroid problems. Did you know that hyperthyroidism has hypoglycemia as a complication? I had my thyroid removed–cancer–and as a result, I must take thyroid, because it’s not home grown, so to speak. Two “endocrinologists” ended up nearly killing me–one with hyperthyroidism and one with hypothyroidism–because they weren’t up-to-date in thyroid, much less how it interacts with DM. for example, if my thyroid is increased, my average FBSs will decrease. So…you can fill in the blanks.

    Maybe developing a card (as a job aid) listing the basics is something to develop and carry with you to wave in front of these “helpers” when you encounter them.

    1. Mary Dexter
      Mary Dexter June 28, 2013 at 6:52 am | | Reply

      Why aren’t medical personnel better educated about diabetes? It’s inexcusable. November is Diabetes Awareness Month. Rather than spread the same stories of gluttony and sloth being the cause, which aren’t helpful, could we push that everyone in a healthcare setting be educated with the latest diabetes findings so these horrors stop happening? They of all people need to become more aware of what diabetes is and isn’t.

  21. Richard
    Richard June 27, 2013 at 10:22 pm | | Reply

    Like someone said, the hospitals don’t know much about T1D. When I go into the hospital, I bring everything needed for my pump and CGM including glucose tabs. They ask me for my test results and I manage as best as I can.
    Unfortunately they put me on their diabetic diet which is so bad that my daughter promised to bring me food that fits into my diet. I never really considered what would happen if I was unconscious. It seemsn like very few
    hospital personnel know much about pumps and CGM’s,
    I think the medical profession is great with the many life saving developments
    in my 52 years as a T1D, however what’s needed is a system prevent problems like your Mom encountered.

  22. Fab Five Fridays: The Zombie Apocalypse Edition | theperfectd

    [...] personal account of an ER visit, you have to read Mike Hoskin’s post over at Diabetes Mine: Diabetes Care in The Hospital: It Ain’t Pretty - not only is it sobering (and I am so glad that his mom is OK!), but filled with great [...]

  23. Natalie ._c-
    Natalie ._c- June 28, 2013 at 9:58 am | | Reply

    I couldn’t agree more. I had my own experience of having the hospital try to kill me. I’ve talked about it before, but for those who don’t know me, here’s what happened. First, my own fault: I binged and omitted insulin. And my BG went up to 600 or so, and I didn’t show up for a picnic I was supposed to go to, so my wonderful friends came looking for me. The last thing I remember is them shouting my name outside my door. I woke up 2 days later, thinking I was in Canada (I live in Reno). And I was so confused, I couldn’t write a check (for the friend who cleaned up my house after the mess I made — she said it looked like a tornado hit it), or recognize my own CDE whom I’d known for years. I was hallucinating really frightening things, and my BGs were staying high. Why? Because the hospitalist eyeballed me and thought I was a T2. I was 63 years old, and not thin, and that seemed to be the obvious conclusion, I guess. The CDE fought with him to put me on T1 protocols, because the T2 protocols weren’t working. Duh. Then, as soon as they thought I was stabilized, they sent me to a rehab hospital AKA Alzheimer’s home. It was a Friday afternoon, and the hospitalist there was off until Monday. And the T1 orders didn’t follow me, so they would only give me insulin as a correction on a sliding scale — no basal, no bolus. So I relapsed into those horrible hallucinations, and was really a mess. Finally, on Monday, I managed to talk the hospitalist into basal/bolus/corrections but he made them fixed doses, and when your BGs are extremely high (I was still running 400-600), you become more insulin-resistant than when your BGs are in a more normal place. So my only defense was to eat almost nothing, and steadfastly refuse carbs. One morning, there was nothing but cereal on the breakfast menu, and I didn’t eat at all — and that day, the dietitian came in to talk to me about it. And agreed to cooperate by instructing the kitchen staff to give me meals with few carbs. Whew! But the net result of all this treatment was that I was a week in the hospital and 3 weeks in the rehab home, when I should have been out much sooner. More money for them, more misery (and bills to pay) for me. As a result, I’m ardently anti-hospitalist, but from your story, they weren’t any worse than the regular staff. My bad luck was that I live alone, and there was no one to care for me at home.

    1. Danna
      Danna May 2, 2014 at 4:04 pm | | Reply

      I once filled an entire page with basic medical mistakes regarding my diabetes while in the hospital. No Lantus if low at night, no mealtime insulin even with juice and a full (carby) meal, mixed Novolo and Lantus in a single syringe, stack insulin every forty five minutes, etc. etc. It is horrifying, and those kinds of swings are both sickening and terrifying. Their egos and lack of education make for a potentially lethal mix.

  24. Joanne Milo
    Joanne Milo June 28, 2013 at 12:01 pm | | Reply

    Ooooh, Mike, I’m so sorry. I love your mom and that’s just so wrong at every level. I’ve experienced that same level of incompetence and negligence in both the ER and as a patient in the hospital. It is terrifying. If you need support or involvement to address this, please count me in! I’ll give your mom a call and check in. So sorry for all the trauma and stress … j

    1. Jim Devlin
      Jim Devlin July 5, 2013 at 11:20 am | | Reply

      Natalie, nice description of what severe hypoglycemia feels like. Even after 61 years being a T1, I have always found it difficult describing this awful event adequately.
      Hospitals use a one size fits all technique to treat all diabetics. My Endo. informed me to tell him as soon as possible about my being in a hospital and he will make sure that I am treated accurately. This was after only two days in the hospital and my glucose was near 500mg/gl.
      In spite of his assurance I will avoid a hospital stay as aggressively as possible.
      Since I started using a CGM three years ago my frequent very low sugar episodes stopped, immediately. I think the Continuous Glucose Monitor is the best T1 improvement since retail insulin, or darn near.

  25. Dan
    Dan June 28, 2013 at 1:02 pm | | Reply

    Hope your mom is doing better. As far as hospital education, there are several initiatives underway to teach both ER docs and floor nurses in hospitals more about the management of Type 1 diabetes. That being said, every PWD should be aware before they go to a hospital, what that hospitals protocols are for ER admissions and post ER care. If you don’t know, find out! Most doctors get about 6 hours of education in medical school on diabetes( trust me, that’s it) and unless you are a teaching hospital or university affiliated hospital, you will probably find the lack of understanding about diabetes(particularly Type 1) mind boggling. There are protocols in some hospitals for patients that are being admitted with pumps, sensors and understandings of self care written up based upon patient condition at the time of admission but these are few and far between at this point. Due your due diligence as PWD’s and find out about your hospital and what their resource structure is for management of PWDs. Whether it’s IV drip of insulin upon admission or self management of your own care protocol based upon your evaluation at admission, you should know!

    1. Mary Dexter
      Mary Dexter June 28, 2013 at 2:01 pm | | Reply

      Just because the hospital or clinic is university affiliated does not mean that personnel will be competent in treating any kind of diabetes.

      I’m sorry this happened to your mother, Mike, and right now you need to take care of her.

      From now through November we need to find ways to rectify this so it doesn’t keep happening. Rather than more pictures of fat people’s stomachs hanging out of grey sweats, could we have more discussions of all the factors that lead to high blood sugars? Could we invest in more than 6 hours of diabetes education during a doctor’s training? [I need 6 hours of university credit every 5 years to continue substitute teaching.]
      I’m not sure where we start. Maybe some of you have ideas?

      1. Caroline Yeager, M.D.
        Caroline Yeager, M.D. June 28, 2013 at 4:30 pm | | Reply

        Sure, Mike,

        Develop training materials for DM basic training, including job aids, post them here and ask our members to send them to the Curriculum committee of their local med school and the hospital nearby.

  26. Jessica Apple
    Jessica Apple June 30, 2013 at 5:12 am | | Reply

    Hi Mike,

    I really hope your mother is feeling okay now. What a terrifying story.

    I’m so sorry you all went through this.

  27. kathy
    kathy July 1, 2013 at 6:32 am | | Reply

    I was in the hospital twice in the last year and both times was very dismayed by the lack of understanding of diabetes treatment by the nurses who took care of me. They were thrilled that I did most of it and asked to see my pump as if it were something very new to them. The wiser ones let me do it all myself. The less wise, tried to dictate when I tested and when I administered insulin. Luckily for me, I knew to overrule them when necessary.

  28. Bruce Miller
    Bruce Miller July 5, 2013 at 4:06 pm | | Reply

    This is EXACTLY WHY my physician Dr. Bernatein (non ADA follower) suggests all of his patients have a letter prepared in advance satin NO %5W (= Dextrose 5% in saline) drip for IV fluids is contra indicated aND WE ARE ALLOWED TO CHOSE our diet CHOICE AND not DIABETIC THAT may KILL US,

    1. Caroline Yeager, M.D.
      Caroline Yeager, M.D. July 6, 2013 at 12:34 am | | Reply

      Bruce, I think you mean D5W = 5% dextrose in saline.

  29. Caroline Yeager, M.D.
    Caroline Yeager, M.D. July 6, 2013 at 12:37 am | | Reply

    Maybe Diabetes Mine can come up with a printed template for our printer with appropriate instructions for

    1. T1DM
    2. T2DM

    Then gather comments and consensus, and have it available online.

  30. sue whittier
    sue whittier July 6, 2013 at 6:55 pm | | Reply

    Hi Mike -

    I’m a little older and have had T1D a little longer than your Mom – and must admit that the concern that what just happened – both at home and in the hospital is why I still use a basal / short acting combo to try to control the BG – nights are the worst for me – always have been – my very senior Mom will attest to that – especially as a youngster. Now though, I must agree with most off the comments – hospitals tend to be places to visit only as outpatients! When I made the most recent visit – first to truma unit for sugery,and then to a rural hospital for recovery [?] as per Bernard Ferrel mentioned – here they asked if I wanted to look after the BG / insulin Tx – and just report or ask for help as needed. That worked much better than he teaching hospital resident [surgical location] that ordered an insulin I haven’t taken since Novo-Rapid apppeard on scene – yrear 2000? And the needles were different length [longer] – that can affect BG as well – or so I’m told. I could write a mini series about this recent event! One thing on my side in the rrural hospital was that both my Family MD and Endo have consulting / admitting priviledges -so I assume there was some communication…. and I had one RN who said a family member of hers felt the best way to survive after a surgical admission was to get out before they did him /her in! [different hospital]- i.e. she had a pretty good idea re my plight! – so now you know Canada is part of this same club – who needs to watch Survivor?

  31. Anonymous
    Anonymous August 14, 2013 at 6:26 am | | Reply

    I had several ER visits and a hospital admission for abdominal surgery (removal of a twisted, necrotic fallopian tube) early this summer. I am a longterm type 1. I use a Dex and was on a pump for over 10 years but for the last year I have been on MDI, doing very well. I was cared for in two good hospitals, one in RI, and one in MA. In both, after asking some preliminary questions and not revealing too much about my care, what I was told was this: If you’re on a pump, and competent, we let you manage your own insulin. If you’re on shots, we administer your insulin for you. So…I never told them I did not have a pump. Every nurse seemed to think my Dex magically administered insulin and that I was all set, and I did not correct this detail with them. I did tell them that I was “also” on Lantus, and that I would be taking my own Lantus each morning under the nurse’s supervision, which I did. Whenever I ran a little high, or needed to eat, I waited till no one was looking and swiftly took a shot of the Humalog in my kit. When the nurses came by to test my BGs, they were nicely in range. On surgery day, they fasted me from midnight the previous day until the surgery at 8 pm, 20 hours. I lowered Lantus appropriately, and sneaked glucose tabs a couple different times, and stayed safe during surgery. I was lucky, and all went well. However, I felt paranoid and uncomfortable the whole time about being less than truthful with the nurses, and I also regretted not educating them properly about up-to-date, patient-managed MDI.

    I have no idea what I’ll do next time I go to the hospital if I’m not conscious and competent. Mike, your mother’s experience is truly frightening. I hope she is completely recovered by now. Thank you for writing about this.

  32. Joe
    Joe October 21, 2013 at 8:04 pm | | Reply

    I have T1 and am a RN, CDE. About 4 years ago I took a job as an inpatient CDE. I barely have time to teach patients because I’m so busy educating the staff (both Drs and RN’s) on how to manage Diabetes. They don’t understand the concept of basal / bolus, the difference between T1 and T2….I could go on and on…The best advice I can offer is to stand up for yourself and don’t take no for an answer when you must be hospitalized. If you’re too ill to do this, take an advocate with you. The nightmare hospital stories here are pretty much the rule and not the exception!

  33. Joanne Geist
    Joanne Geist January 18, 2014 at 10:48 pm | | Reply

    I am an RN for 40 years. I had Type 2 Diabetes for the last 10 years following RAI treatment for a toxic thyroid nodule. I went thru the gamut of one drug after another to achieve decent BG control. My Endo told me I was “Insulin resistant” so was given a combination of many drugs to achieve decent control. In all my daily regimen was 850 mg Metformin Bid, Amaryl 4 mg daily, Avandia 4mg daily & Byetta injections 10mcg Bid. After several years the Avandia caused substantial weight gain & peripheral edema & was discontinued. In late 2010 I began to feel sick on a regular basis with nausea, vomiting. Being in the healthcare field is not easy as they are not forgiving on frequent sick days so I came to work & tried to manage until one day I passed out at work. I was sent to the ER where the did many tests, thought I initially was a cardiac patient but was admitted when they could not come to a conclusion.
    So despite repeatedly telling my medical history to many Drs & nurses & listing all my meds, I was NPO for 4 straight days as they did many different tests all the while withholding my meds & giving me Insulin even though I told them I was “Insulin resistant”. After repeated injections & Gluc checks my sugars were in the 300′s, some of the highest I’ve ever had except while I had been on Cortisone injections. Long story short ….. Eventually after 4 days in the hospital and 6 different procedures I found out I was borderline gastroparesis, my Gallbladder had stones but never had any pain. It was not functioning found via a HIDA scan. Also found out somewhere along the way I had experienced a mild, silent heart attack. Was discharged due to New years holiday & had Gallbladder surgery in early 2011. Had complications post surgery with atelectasis(collapsed lung) It took several weeks of getting back on my meds to gain any semblance of control. My Endo did not see me in the hospital because he is from another Health network. The following month both my Endo & my new Cardiologist decided I needed to do something to better control my sugars especially with the fear of another silent heart attack possible. It was suggested that I look into Gastric bypass. I was very hesitant to allow myself to re-enter a hospital for a 3rd time. But after much research & support I had the surgery while battling insurance due to not having the weight/BMI required but I had several co-morbidities & was finally approved. Chose a different hospital, had the surgery without event and after having 15″ of my duodenum removed & with all the underlying mechanisms that occur during this surgery 2 days later I left the hospital , OFF of all my Diabetes drugs and a blood sugar of 90. In the next 6 months my A1C went from 7.4 to 5.4 & continue to have excellent BG control. So this surgery essentially put my Diabetes in remission( hesitant to say cured) Completely reduced my cardiac risks & ended the vicious circle of meds. Now I only take a heart pill & the vitamins required due to the GBP.
    So as a health care professional I saw first hand how Diabetics are mistreated. It is a scary experience & hopefully for me will never happen again. Every Diabetic patient & family need to be informed & proactive for their own good & patient rights until the current hospitals & staff become better educated on Diabetes management. Most hospitals will treat T1′s with BG/sliding scale with Novolog so if you take Lantus plus other insulins you may need to educate your nurse on what you need IF they will listen to you. Hope your Mom has recovered & doesn’t go thru this again.

  34. Dolores
    Dolores January 23, 2014 at 1:29 am | | Reply

    The best way to avoid issues in the ER: have your primary doctor or specialist write a letter stating what your treatment should be in case of an emergency. This has saved me a lot of trouble in the past. If you have a letter with an emergency treatment plan, and ask the the ER doctors to follow it, there isn’t any confusion and it puts the liability on your own doctor, so they are more likely to follow through quickly instead of doing a ton of other unnecessary tests.

  35. Jo Momma
    Jo Momma February 23, 2014 at 7:30 am | | Reply

    Yeah… I’ve been hospitalized SEVERAL times and my experience with insulin coverage while under their care is really, REALLY bad. ER/hospital staff giving me shots HOURS after dinner, (oops busy)… Giving me doses not sufficient for my needs per my and my doctors instruction. (2 units coverage for 2/3rds of an entire day? When I really require much much more.(insulin resistance).

    Last time I was hospitalized I supplemented insulin doses by hiding it by my bed and taking shots when I needed it. Went much better that way.

  36. Is It Stigma that’s Killing Us?Twice Diabetes | Twice Diabetes

    [...] insulin despite established, documented type 1 diabetes and the presence of high sugars is commonplace.  Anecdotes shared on social media sll too frequently include teenagers with diabetic ketoacidosis [...]

  37. Jessica Bunch
    Jessica Bunch July 19, 2014 at 10:05 pm | | Reply

    I recently had a experience I would like advice on, I was admitted having DKA 3 months ago, they kept me one day and then released me…anyone knowing anything about dka knows it cannot be treated fully in a day. I was recently admitted again for dka, and the icu dr said I have been on the verge of dka for the past 3 months cause I was not fully recovered when released last time. Can I sue for anything cause I missed out on work for being hospitalized for 3 days this time….which is the hospitals fault for not treating me properly the first time I was there. I would like opinions on what I should do?

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