FUDiabetes

A little Vent from a cranky nurse who had to be a patient

Let me preface this by saying I have been an RN for 37 years. Most of my experience has been in L&D. My current position is with UAMS in their Institute for Digital Health and Innovation. I am an ANGELS nurse. We triage all of the women’s health patients as well as handle all of the OB transfers and consults. We also back up our state’s stroke program ARSAVES. We also back up 2 other programs.
So I was sitting at my desk answering triage calls and getting ready to attack the list of follow ups we had (we also call every patient we send in as well as all discharges from women’s) when I started to feel off balance. It was a very odd feeling, dizzy without any room spinning, like I needed to hold on to something. I blew it off for a while and then because it did not go away and it had been an hour, I asked one of the telemedics who do only the stroke program what they thought. Well, long story short, I got a little worse and finally decided it was stupid to sit here and potentially become a bad statistic so I called my boyfriend and he took me around to the ED. They eventually called a code stroke and I went to get a CT and CTA. Neurology came down immediately and said they saw no evidence of stroke but my right vertebral artery was not showing up well so they were going to admit me overnight for an MRI and MRA of my head and neck. (My sensor did fine during and after the CT/CTA but I removed it for the MRI) Anyway, I asked about my insulin since they actually allowed me to have a diabetic diet. Now mind you all of my meds are on my EMR since I go to a UAMS Doc for my diabetes. The nurse says Oh they just ordered a sliding scale. Umm NO. NO NO NO NO!. Why would I want to chase my freakin blood sugars and ruin my work so far to keep my A1c under 6?? So he goes to the Resident and tells her I want to be on my routine meds. She comes in and gives me some ridiculous speech about how much insulin I am on and making SURE I eat… Ummm ok… now mind you I have been managing my diabetes for 5+ years now. So I agree of course… It just made me so angry that this was the norm for almost every single non Endocrine service except OB. OH and they ordered fasting and AC bloodsugars. I tried to explain that if they truly wanted to know how a diabetic was doing, Fasting and post prandial bloodsugars are how to do that. I then stopped because it is like beating my head against a brick wall. I am just so disappointed in this system. Diabetics need to be able to properly control their blood sugars whether they are in or out of the hospital. I never decide to just blow off my long term insulin and switch to a sliding scale. To me that is blood sugar suicide. It’s like chasing your tail. OK, I feel better now. Thanks for listening.

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OH I forgot, MRI/MRA showed my right vertebral artery is blocked probably due to dissection but there is plenty of collateral circulation. I am now on a baby asa forever and Plavix daily for 3 weeks. My symptoms thankfully resolved around 3pm that day.

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Really glad that your symptoms resolved and everything is going to be ok. On the diabetic management front, it is truly astounding how hard the system works against patients sometimes. Glad you are out of the hospital and able to continue your excellent management. btw, Remember to Eat. (that last bit was sarcasm, hope it came out that way)

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Sggmom62, I am the mom of a type 1 teen and also a physician. It’s pretty remarkable how little even internal medicine trainees learn about insulin management, since the vast majority of diabetes they see is not insulin dependent, or using only prandial insulin. I was rounding with a team of residents a couple of years ago and as we stopped in front of the patient’s door, found out they had held all insulin including basal on a TYPE 1 patient overnight because she was fasting for an imaging test. I went a bit ballistic – had them go in and stand while I called for a finger stick which of course was 400ish, then had the patient explain to them why a type 1 doesnt stop needing insulin just because they don’t eat, and gave them a harangue about how embarrassing it is to forget that there are two diseases named diabetes. I’m pretty sure it’s seared on all their brains :grin:. So you’re not the only cranky one!

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I hope that you are feeling better ma’am. I feel your pain. I am a RN/APRN/Diabetes Educator and this is my fear if I am ever admitted to the acute care hospital setting. I would call the personal cell phone numbers of the hospital endocrine team and make my own endocrine consult. I would request my basal, prandial, and correction insulin. I work day and night/24 hrs a day to keep my a1c at or around 6.4% for some incompetent mess ups, not to mention DKA feels horrible.
We also have a hospital policy where the PharmD can evaluate a patient, so thier own insulin can be administered and an insulin pump policy.
I also, have a written advanced directive that states, if I am unable to make decisions for myself ‘please at least give me basal insulin, even if I am actively dying’. I do not want to die from DKA.

*Be your own advocate and demand the insulin. These issues can also be escalated up the chain of command to a hospital administrator.

I am sorry to hear about this.

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In today’s world this is so unbelievably ridiculous.

Infuriating and yet not the worst of the story…

@katiereeder, a great story that I will use often. Shocking, of course.

@JW_dx2002, what a great idea! That is definitely something we need to add to our hospital list.

The lesson I have drawn from all the stories I have heard and read is that the moment a T1D is admitted, their risk of death goes much higher. At this stage I would never leave my boy in a hospital alone: I would have my bed by his side day in day out.

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I had my endo write a letter with his “request and orders” that I be permitted to continue to use my own equipment and supplies to manage BG if I am ever admitted to the hospital and I want to. A copy of this letter will be carried with me (or be delivered by my spouse) if I go to the hospital, and will be pre-submitted to my chart for elective procedures. I think this approach is much stronger than simply hoping that the hospital staff will let me do it.

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I have seared a few residents in my long career as an L&D nurse but I find it very comforting that OB seems to be the only specialty that takes care of their diabetics appropriately. We keep them on their insulin, do fasting and PP blood sugars and encourage type 1’s to please for the love of that baby and yourself keep that pump going!! LOL I think the last time I kinda reprimanded a resident for telling a mom she would be really quick so it wouldn’t be too bad…with a cervical exam. I was horrified and told her so, in the hall… Yikes!!

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Good idea.

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