FUDiabetes

Why are hospitals treating diabetes the wrong way

i was in the hospital this past monday till weds morning due to a DKA. every time im in the hospital for it they treat diabetes the wrong way. they ER dept gives me the fluids i need including the insulin drop which is correct. they check my sugar levels which is correct but once i am transferred to the medical floor is when its different.

on the medical floor they check your sugar levels but depending on where you are they take a while to give you the insulin. they also do the sliding scale which doesnt work for me anymore. i have to let them know that i need the long acting as well as that covers the day and night. before a meal i get my levels checked and wont eat until i get my insulin. i decided to go ahead and eat anyways as i know they are busy with other patients. but they need to know that a diabetic needs their insulin. then i have my sugar levels checked after my meal and sometimes it will be high due to not getting any insulin as they do it on a sliding scale or not enough insulin and they wonder why and i have to tell them why and tell them i need insulin to cover for the high. i spoke to the diabetic nurse educator who im on a first name basis with as she has seen me in the past. i didnt mention how it suppose to be but she did help me get discharged on weds so i can see my endo as she thought that was important. but next time i see her ill let her know how i feel about how the treatment is. its archaic. i even told my eno that they need to learn how to do diabetes in modern times now. he agreed. so next time ill have my pump out as i cant use it while im on a drip and ill figure out how much insulin they need to give me. also on a side note they dont give me all of my meds im on as they dont have some of them. so next time ill make sure im allowed to take what i have with me.

anyways, does anyone else have this issue or am i the only one that has an issue? i love the hospital as they really take care of you well and the staff makes sure your ok but the way they do diabetic care isnt up to par.

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@amymc It has been my experience that unless pre-arranged, they give you as little insulin as possible so you don’t go hypoglycemic for any reason. All hypoglycemic events are reported to Medicare regardless of patient age, and affects the yearly hospital reimbursement rates, so most medical institutions have a healthy fear of a patient going low. It sounds crazy, but apparently money is more important than your long term health.

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so they rather see us high to keep us as long as they want? thats redicilous. ive been low before when i was in the hospital…but it was fixed in time…and it wasnt because of too much insulin. i just went low. they need to learn that our health is in their hands. if one thing goes wrong they can be cited (this is what i learned as a CNA). it just doesnt make any sense.

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I don’t know if my experience is unique or shared by other Canadians, but every time I’ve been in the hospital, I’ve retained full control over my diabetes. Sometimes the nurses ask me to let them know every time I test and dose insulin so they can record it. Sometimes they just leave me to it.

But our healthcare system isn’t driven by money the same way it is in the US…

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everything here is all about the money instead of the people. it doesnt matter whether its health insurance, etc or not. i wished we were like other countries that care

That has been my experience,and has been reinforced by the nursing staff on my last 3 hospitalizations this year. One other thing to keep in mind, when you can’t speak for yourself or your Endo isn’t available the staff doesn’t know your ICF, DIA, or anything else about you. When you can speak for yourself, they will generally take into account your information but with all the potential liability a fasting range of 120-350 is considered acceptable and safe. Then again for someone who presents as hypoglycemic the ICF, DIA info may be discounted. For someone who presents as hyperglycemic they seem to be more willing to listen.

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ICF, DIA? do you mean insulin correct factor and diabeties? those initials ive never heard of…they asked who my dr was and i gave them the info…he should be in the systen from last time, etc. next time im in the ER ill have them call the line and have them page him.

yes, insulin to carb ratio, correction factor duration of action, etc. Additionally, insulin has a faster onset & tail when delivered through an IV.

ah ok…i never heard of the DIA. that is a new one for me. i should still have them give me the long acting while on he IV

My husband’s a nurse in a hospital, and I have to sort of tune him out if he talks about how they manage diabetes on his floor. :laughing: The sliding scale is all they use, and yes, they tend to err on the side of under-dosing to avoid any lows. It drives me crazy and makes me hope I don’t ever have to be in the hospital too much…
Side note - so sorry you were in DKA; glad you’re on the mend!

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thanks…i was happy to get out of there…i thought they were going to make me reschedule my appt but the diabetic nurse that i know made sure i went. which was a good thing as no one called my endo about the fact that i was in the hospital. they couldve had him paged and he couldve of given them advice

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Yikes. Sounds like when my mom was in the hospital a few weeks ago…they flat out refused to call her cardiologist.

Oh, and also, they go off the ADA blood sugar goal ranges, so <180 1-2 hours post prandial, meaning if you’re 200-250, it’s high, but to them it’s not that high, especially since you’re typically sick when you’re in the hospital, which raises your BG levels. Same with fasting - anything below 130 goes, even right before eating, so they’re not going to worry about a 150 fasting level too much. They just have different goals compared to most of the crowd on here. :blush:

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We need to persuade Dexcom that they can make humongous amounts of money selling a G6 that looks like this: blood glucose monitor [not], it fits in just above and to the left of the coffee table at the foot of the bed here:

Where to put the BG monitor [instructions not intended for adults]. You have to dispose of the keyboard [remember that keyboards contain chemicals know to the State of California], but, really, what are keyboards for?

Of course the G6 sensor has to be wired, but I’m sure any number of the guys who replace the batteries in a G6 can simply take an old transmitter and wire in 10 gauge (oxygen free copper, multistrand, flexible, silicone insulation MTW+) cable to connect to the Monitor.

Yeah, yeah, I know this sounds sarcastic but it isn’t. Hospitals really care about cardiac failure, given enough time and enough lawsuits we can make them care about messing with our blood sugar. To be realistic the current situation is as though when we enter hospital we are required to do 20 a day. A BG monitor, while it would certainly be expensive because in our country we have to make money (that is not sarcastic, or ironic, it is a statement of fact) is a more reasonable expense than an MRI.

John Bowler

it is true that this is a money making medical area. its a shame that it has to be that way. i just wished they cared more about diabetes. yes the nurses has many patients but they should at least get to know their patients so they can better care for them, etc

Would make more sense for hospitals to use Libre, and include in charges for any diabetic admitted. Especially once the Iibre 2 is available.

The use of CGMs seems to depend on the hospital from my experience. The last one I was in recognized the value of a cgm, but would not allow me to make treatment decisions based in it. No finger stick, no insulin. I made arrangements to manage my own insulin prior to admission, and told them what they wanted to hear. As the days progressed I discovered why. They are completely responsible for your health and safety while admitted. Not all diabetics have the same knowledge, understanding how it affects them, or desire to manage their diabetes. Given that, the hospitals make rules based on the lowest common denominator - the patient who does not actively manage their diabetes. During my last hospitalization, once the nursing staff recognized that I was actively managing my diabetes and could demonstrate effective treatment\corrections, they just asked me what my current bg was and if I had taken any insulin.

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if i had my cgm i wouldve of avoided the hospital trip but i was waiting for the new transmitter to arrive and it took the 5 days to ship it to me vs shipping it right away and getting it here sooner than later. i ended up getting the package on tuesday instead of the week before…it took dexcom forever to get it to me and ive been trying to get it for a few weeks. dont get me wrong that they did an error but i love my dexcom.

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Back in the early days before home BG meters, I was in the hospital for several days (for vitrectomy, which is now office/out patient appt!).
At 6am, nurse would draw blood, and 1-2 hours be back to give insulin based on that draw. I was using NPH+R at that time. I would do a visual Chemstrip BG read, which of course was always much different, but they would not use it.

So in some ways, things have improved.

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@MM2 I would agree with you that hospitals have evolved - slowly. I personally would have had a difficult time using R & NPH then waiting 2 hours to correct. When I used R & NPH in another lifetime (pre-health insurance) my day was highly regimented to try and mitigate the rollercoaster of peaks and tails while avoiding inadvertent stacking at all costs.

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