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Hospital Stay & Diabetes Management

9865 Views 44 Replies 12 Participants Last post by  MinisMom
When I was in the hospital the first week of August, I was concerned about how I would manage my diabetes. Medications are usually given 4 times per day except PRN meds. The hospital did not use carb counting so I needed to come up with a sliding scale for my Novolog injections. With the help of my doctor, we came up with a decent dose that would cover meals, the increase due to infection and to cover the increase in blood sugar due to the steroids that I am on. We settled on 25 units at mealtime and I am used to taking my Novolog after meals but found that this was going to be difficult to get my shot at this odd time so I took the chance and was getting my Novolog before meals, this made me nervous to say the least. And then I was nervous about the size of the carb servings, which were mostly small except for the "modified mashed potatoes" that was served nightly. I would get my blood checked at 6AM, 11AM, 4PM AND 8PM. I remember one morning I tested at 65 and you would have thought this was the end of the world. The nurse brought regular chocolate pudding, 3 packs of graham crackers and a carton of milk and told me to eat up. I ate the pudding but didn't eat the rest and they kept testing my blood glucose to see if it had come up. I explained that this was a low number but not for me. If I would have eaten everything that they told me to, I would have then been high. And what they gave me to eat was not exactly fast acting carbs. I also had several times when I got my Novolog 2 hours after eating and then I was due for more Novolog in 3 hours and refused a couple of shots. Diabetes management really needs to be stepped up while you are in the hospital. If there is a next time, I will have my glucose meter brought from home and will smuggle in my own Novolog. Oh, they also don't stock Lantus so I was using Levemir.
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As people with diabetes, what recourse or (in this case), action can one take/do when it comes to implementing our daily prescribed medication routine when in the hospital?

Don't you think it would be better for us (being in the know), to continue on the regimented routine we've been accustomed to instead of bowing to the whims of the nursing/hospital staff?

BreezeOnBy brought up something that I had never considered, so..

"What Say You!?"

Breeze 2 User
I even asked if I could keep the insulin pens with me and one of the nurses told me that was against hospital policy. The injections have to be given by a nurse. Our diabetes management is left in the hands of nurses and hospital staff. I wasn't even able to get a correction bolus when my blood sugar was over 200. There was simply nothing that I could do except not eat and I wasn't about to go hungry. There was a diabetic meal plan with little to no options. You ate what you were brought. :hungry:
Isn't it a shame that they're willing to compromise a patient's wellbeing just to cover their own butts?
You are so right! Get your guns back out! :D
Isn't it a shame that they're willing to compromise a patient's wellbeing just to cover their own butts?
I forgot to mention that I had 2 nurses that left the keys in the medication drawer in my room. I was just busy looking around, since I had nothing else to do and happened to notice the keys in the drawer. That was totally careless and unacceptable. It crossed my mind to take the novolog pen out of the drawer but there were no pen needles on it.
Never forget that you always have the AMA (Against Medical Advice) option. You can refuse any part of your care. You can also simply leave the hospital. The hospital policies are indeed in place to cover the ass of the hospital, not ensure optimal care. I ought to know, I'm a nurse who actually worked in a hospital for a while.

I agree that it would be a fine idea to have a specific diabetes self-care standing order from your physician, much like your advanced directive. Keep a copy in your hospital record, and you keep a copy at home, too, for when they lose the copy in your records. But the hospital will hate it.
My PCP was making most of the calls, we discussed my diabetes care plan the first day that I was in the hospital. We knew that carb counting wasn't going to be an option so we came up with a sliding scale to use. I was way too sick to think of going AMA, I needed to be in the hospital. I just wish that taking care of diabetes while in the hospital played a more important role and those in charge would see that things like giving insulin on time should be a top priority. When I asked why my insulin was being given late, I was told that the nurses have to give the meds within a certain time frame. And they had an additional hour in which to give meds and they still would be considered giving the meds on time. What really got me was how willing the nurses and techs would give you any kind of juice if you asked for it. Fruit juice is loaded with carbs and no one seemed to care. And then the there was a guy from physical therapy who gave me 4 packs of graham crackers and two tubs of peanut butter for being "a good patient", no questions asked if I was under any type of dietary restrictions. I know I didn't have to drink the juice or eat the crackers, but I was on steroids and I was hungry all of the time. Even the best thought out plan for your diabetes care while in the hospital will fall by the way side if a nurse or tech has a more pressing issue to attend to. That is just the way that it is.
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Got my detailed bill from the hospital yesterday and I was shocked at what the hospital was charging for insulin. They charged a $1.00 per unit and my Actos was $10.67 per pill and my Glipizide was $3.25 per pill. I laughed at the price for a 750MG Levaquin pill-it was $26. This is highway robbery!
Oh Breeze . . . that really is insane! And it's criminal that they can get away with it!
My pharmacy bill was over $4,000. I take 80 units of Lantus every evening and the hospital made some money off of me and my insulin needs.:eek: You can purchase an entire vial of Lantus for $125.
My turn to rant...a few months ago I ended up in the ER for kidney stones....for 2 hours in the ER, 1 CAT scan, 1 bag of fluids, 2 Lortab and 1 anti-nausea..........$19,430. That's what they billed my insurance, the hospital agreed to accept $1,943 as total payment (more like it). The problem with this is that the entire $19,430 is applied to my lifetime maximum on my insurance...being a diabetic means I'm gonna need ALL of my available insurance for my lifetime. :shocked:
This is a shame. Now, I don't feel so bad. I was under the impression that with the new health care reform that there was going to be no lifetime maximum on policy benefits beginning 9/23/10. Someone correct me if I am wrong. All of the health care reform is really confusing. And it is too bad that most of us will have to wait until 2014 to reap the benefits.
I have not gotten any notifications from our insurance company as of yet. I checked their web page and did not find anything either. But you never know, they really like surprises. :confused2:
I got my info from an article that was in the August issue of Diabetes Forecast. I will see if I can find out some more info.
I just spent another week in the hospital and it seemed that I had to struggle to manage my diabetes during my stay. The 1st night, I had a go around with my nurse who would not give me my 9PM dose of Lantus. He told me that he could not give me that much insulin since I had nothing to eat all day and was too sick to eat a snack. I didn't have the strength to argue with him so I went without my Lantus. You would think that a nurse would know that basal insulin does not work like rapid acting and you should be able to take it without food. I also could not take my Metformin, since I do need to take it with food. The first few days in ICU, I was not hungry and wasn't eating very much and had other nurses who wouldn't give me the right amount of Novolog and Glipizide. One day, I had a nurse who would not give me my Novolog and I had a good meal and plenty of carbs. She told me since my pre-meal blood glucose was 72 that I didn't need the Novolog. I then found the patient hotline phone number for the hospital and I called and reported that my nurse was playing doctor and not following my doctor's order for the sliding scale that he wrote. The head nurse for the floor was at my bedside within 10 minutes and I stated my case and she tried to make all kinds of excuses which I didn't care to hear and told her that I knew my body and what was needed to manage my diabetes. I then received my Novolog at meal time per doctor's orders. I also tested low on two mornings and was forced to drink large amounts of juice to raise my blood glucose. I honestly, felt like just leaving the hospital against medical advice since it seemed that the nurses did what they wanted and was in control of my medication and there was nothing that I could do about it. I was losing my patience with the nursing and PCA staff and everyone was paying the price of my frustrations, I got nasty with a few of the staff and didn't care. I will never go to the hospital again without taking my own diabetes medication. NEVER AGAIN!
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Well, if it is any comfort, with the neew healthcare law,your insurance company can't set a lifetime limit on your insurance. There is no CAP to what your insurance will cover.
That is what I thought. But isn't there a clause that shelter some insurance companies? When will this become effective?
November Hospital Stay 11/13/10 To 11/18/10 Diabetes Management

I know that I said I would never go to another hospital without taking my own diabetes medication, but I needed to go and didn't have my insulin and syringes all together and I think I was pressing my luck on getting the medic to allow me to gather a few personal items to take with me. So I was officially admitted on Sunday 11/14/10, I was taken to the ER on 11/13/10 but things were moving very slow all night, I was told my bed was ready, but the Doctor had not written the orders. and I asked every hour since the bed/guerny was the most uncomfortable thing I have ever laid on. Every time I asked about the doctor order I was told "oh about 15 minutes", I heard that for about 4 or 5 hours. I don't know what happened but my PCP was not on call and was told that a hospital doctor would be writing my order....not sure why the doctor on call didn't confirm the orders, but oh well. I said "oh well" and kept asking and didn't care how many times I repeated myself. At midnight, I was told "15 minutes" and said OK and the most uncomfortable things started to happen, first of all the ER must have cleared out quite a bit and my curtain was closed and I could not get out of bed without pulling out the sensor or heart leads or IV and no one gave me a call button and my oxygen now flowing at 10 liters was 7 ft long and I need to go to the bathroom and I didn't know what to do, so I started calling for a nurse and no one came, strange enough there was several people who went by the ER room and did not ask if I needed help...I continued to call for a nurse and there were 2 people exchanging personal phone numbers and chatting about who they were and neither one of these people asked me if I needed help. OK, I was getting no where fast so I started yelling "help" and this went on for another 20-30 minutes. About 1AM my nurse poked her head in the curtain and said "do you need help"? I told her I had to go to the bathroom and she pulled out the bedpan and said she would be back. I already tried to go for her to get a urine specimen and I could not go, I have a shy bowl and bladder. She did a straight catheter and all she got was a tiny output...dah...I had nothing to drink all day and they gave Tylenol for a fever at 7PM with a small gulp of water, I was a little dehydrated, so I didn't know how much I had to go...beside the point. So once again I was left alone but the nurse gave me a call button....too bad nobody cared or payed enough to the call button. I wanted some more Tylenol since everything ached, "I started crying" and the Nurse eventually came back in, but said they were getting my orders ready and she would be back with them and I could get my pain medication when I got to my room. I said OK, but had lost faith with all these people. At 2AM, they started unhooking several things, attach my heart monitor to a mobile one and got my oxygen switched to the canister and the nurse had my papers in his hand. I didn't care where they took me, any bed had to be more comfortable than the guerny. I got a room 6 down from the last time I was in the hospital and was glad to be somewhere other than the ER. I got my Norco and a pitcher of ice cold water and it all went down fast. I was allowed to use the restroom with assistance and the nurse helped me, I really feel sorry for my roommate with all this going on a 3 in the morning. The nurse did his check over and asked me the dumbest questions in the world and told me to just try to relax, it was now 4:30AM. The hospital world runs 24/7 and I knew that they started taking blood at 6AM and things start to happen, vital signs, etc. I didn't get my basal insulin which I didn't like and at breakfast, this doctor who admitted me had put me on a sliding scale for my Novolog and you had to be over 250 to get 2 units of Novolog, that would not cover the cold cereal they served. I needed 15 units to get back to 110...what a joke, but I wasn't really hungry and was too sick to complain. Even after my PCP started coming in on Monday, I forgot to have him change the sliding scale to something that made sense...I just said that I would not get bent out of shape over this. The person who went over my medication list, changed a bunch of stuff and several of my medications that I take 4 times per day became PRN. You have to be your own advocate and speak up! I was hoping my first day would go well. I had a chest scan and the breathing treatments were set up PRN instead of every 4 hours, I got that changed to round the clock. My roommate was an elder patient who had her family with her from 7PM to 10PM. I saw 3 doctors the first day and my pulmonary specialist told me he could do nothing for me except administer antibiotics, order breathing treatments and adjust my oxygen. He will not do an open lung biopsy like he promised in October, once again, he said I was in no condition to go through that surgery. I am going to go and see a specialist at OSU to see what he has to say. Well, that is all for now.
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Hi Breeze - what an exhausting slog. I hope those anitbiotics are kicking in and resolving things - the sooner you get out of there the better. Hospitals are no place to get well. How can they expect you to heal with blood sugar running high???? That makes absolutely no sense. Will you be able to self-administer your insulin soon?

A big hug to you - feel better soon!

I was discharged on Thursday afternoon. I keep hoping that I can get out of this scenerio of being in the hospital every month. As soon as I get home from the hospital, I test and bring down any high blood sugar. Seems like as long as the hospital knows that you have diabetes that readings in the 200-400's do not seem to bother the nurses that much. Boy, test low in the morning and they are right up in your face with orange juice and dextrose if needed. Too bad that orange juice does very little for me. It just doesn't raise my blood sugar but about 5 points after drinking 8-12 oz.
hi breeze when i read this i thouth you should have someone go with you when you go to the hospital. well i hope you will get feeling better.
Thanks James for the well wishes. I really don't have anyone who can stay with me while waiting for hours in the emergency room. My Mom uses a walker and can't sit or stand for very long. If I would have been thinking more clearly, I would have made sure that I knew where my call button was to call the nurse. I only discovered that I didn't know where mine was until I needed it. That will not happen again. I have never felt so alone and neglected in my entire life. I am happy to be home! :)
I realize that quite often I am late to the party with information, but still I offer it in hopes that it may help others. I have two blogs that are about being hospitalized.

The first is here - Exploring Diabetes Type 2: Hospitalization concerns for persons with diabetes, and the second is here
Exploring Diabetes Type 2: Hospital Awareness for People with Diabetes.

Good luck.
Thanks for the info. It is very useful. I have had enough of hospital diabetes management. I hate the sliding scale, it does no good for someone who has a poor IC ratio like me. One day, I got 2 units of Novolog before a meal and I was already at 247. It probably lowered my blood sugar by 20 points and then there was no coverage for the roast beef sandwich, cottage cheese, a jello desert and sugar free hot chocolate. I was also getting an IV antibiotic with 5% dextrose. Some nurses don't like people who speak up about their diabetes. I am not trying to act like I know more about diabetes, but I do know my body and how it reacts to foods, beverages and most medications.
I am sorry you had such a rough time. All hospitals have a patient representative. I would definitely let the patient rep know how you were treated so the hospital can improve their patient relations and patient care.
I did report the way I was treated in the ER. I must have talked to 4 different people. I was told the nurse would be put on probation pending the investigation. I was treated poorly and "I am sorry" from 4 different people, didn't make the situation any better. The bottom line was you just can't neglect a patient if they are calling out for help, who knows what might be wrong.
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