In March, 2006, I was admitted to the hospital in Pittsburgh to have surgery on my foot. That hospital was a bigger hospital with better doctors so they were more “up to date” with the fact that you should not withhold insulin from a Type 1 diabetic. Like most hospitals, the nurses have a schedule they try to follow. They would come in about 6 AM to test my blood sugar. Breakfast would come about 8 and they would come around and give insulin for breakfast based on what my 6 AM blood sugar reading was. The problem with that is that I have dawn phenomenon (DP) so my BS starts rising pretty fast once I am up in the mornings. I can have a normal BS in the 80s at 6 AM but easily be over 200 by 8 AM if I am not given insulin.
I did talk to the doctor in charge of my insulin and he wrote an order that the nurses were not supposed to check my BS until closer to 8 when they were ready to give my insulin. My insulin would be based on what my BS was then – which by then, would be high. That worked better until Saturday morning. I had my surgery Friday afternoon and they came early Saturday morning to take me down for an x-ray. I was right around the corner from the nurses’ station and could hear the nurse assigned to me for that day complaining about having to check my BS at 8 instead of 6. She said she was not going to do that and she did not do that the days she was assigned to me.
If you read part 1 of this story, you might remember that I said I recently read something that reminded me I wanted to write about this. Julia on the ADA boards wrote about what happened to her in the hospital. Julia is Type 2 and also insulin resistant. If you know anything about being insulin resistant, you know that someone that is insulin resistant needs a lot more insulin than normal to get the insulin to kick in. Julia said that she normally takes 60 units of Novolog with her meals. The doctor did not order insulin with her meals but had her on a sliding scale starting at 2 units when she was over 150. You don’t need to be a rocket scientist to figure out that 2 units is not going to do anything for someone that normally takes 60 units with a meal. She was also on steroids while in the hospital and that even compounds the problem even further.
Julia also said that the first night she was there, the nurse did not give her the Lantus because she was afraid to give so much insulin! Granted, I can understand the nurse being concerned if she is used to giving someone 20 units of Lantus and all of a sudden, she is supposed to give 130 like was ordered for Julia. The first thing the nurse should have done was asked Julia how much insulin she normally took. That probably could have cleared up some confusion without questioning the doctor. Even if the nurse still was not convinced, she could have double-checked with the doctor. But no, instead the nurse decided it would be better to just not give any insulin.
Stories like Missy’s, Julia’s and mine are fairly common A lot of people need more insulin than normal when they are sick and it is a fight to even get the bare minimum. When I was in the hospital and had my insulin withheld, I was pretty sick and it is hard to fight for stuff when you are sick. Like I said in Part 1, I plan to fight in the future if that ever happens to me again, but if I am unconscious or super sick, that might not be possible.
When we are at home and our doctors write a prescription for a drug that we have never taken before, most of us look up information about that drug. When we are in the hospital, we are being given drugs that we don’t normally take and most of us are not sitting there with our laptops able to look up information about that drug. Prior to reading about what happened to Missy, I never thought about the need to look up the drugs we are given in the hospital. I think the hospital pharmacy should be required to give the same printouts we get from our regular pharmacies!
I know it is not always possible to have a family member at the hospital with you to watch out for what is going on. My sister dropped me off at the hospital in Pittsburgh on Tuesday afternoon and they did not come back until I had my surgery on Friday. It was too far away to come back and forth every day.
Sometimes we are in a particular hospital because that is where the doctor that we like goes. You might hate the hospital but like your doctor so using a different hospital is not necessarily an option.
It is important that you know your rights. You can tell the doctors that you want a self management order put on your chart so you can take your own insulin. You know your body better than anyone else. I can just see trying to explain to a nurse that I have DP and even though my BS is 80, I need to take 1 unit of insulin – they would probably freak!