Hospitals No Place for Sick People?
S.N. has had type 1 diabetes for 46 years, since the age of two, and she manages her diabetes carefully with good results. Yet during a recent hospitalization in a facility that is known worldwide for its cutting-edge medical care, she found that attitudes towards inpatient diabetes management leave a lot to be desired. She writes:
"The protocol was to test blood sugars every four hours or so and make adjustments. While not a bad idea, it never allowed for meals. If a meal came and your blood sugars were 120 they would not allow for the meal. I kept asking and asking for insulin. Finally I just ate the meal to prove my point. Later, when it was testing time and the sugars were 400, instead of seeing that I was right, I would get comments like "you sure are brittle." So from then on whenever food was placed in front of me I took my own insulin to compensate for the carbs. I can look at any plate of food and know exactly how much insulin to take. Later, with comments like "see how good your sugars are," I confessed to taking my life in my own hands. I was severely scolded for having a "stash" of insulin as though it was a narcotic or something...I feel that not matter how hard I try, the medical system doesn't try for me..."
Unfortunately, S.N.'s experience is not an isolated one. Despite the evidence that controlling high blood sugars in hospitalized patients with and without diabetes saves lives and shortens hospital stays, patients often have to push their inpatient care providers for aggressive blood glucose management.
The good news is that several major healthcare organizations have now brought the issue into the spotlight. Last month, the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) jointly issued a new position statement recommending more aggressive management of diabetes for hospitalized patients. The guidelines suggest an upper limit of 110 mg/dl for patients in ICU, and a preprandial (fasting) upper limit of 110 mg/dl for patients in non-critical-care units (the recommended postprandial, or after meal, upper limit for non-critical-care patients is 180 mg/dl).
RELATED: Avoiding Hospital Jeopardy
Comments
- At 01:51 AM on Fri, Apr 21, 2006 JD43years wrote:
Dear Etie Moghissi,MD
My Name is George Detweiler and I have had Juvenile Diabetes for almost 44years in Oct. A Diabetic has to set a certain time to check Blood Sugars and make sure to deliver extra Insulin as needed, Reg I mean. Exercise is the key, any movement including exercising the brain would help. The Ghost effect in which a Diabetic uses Reg Insulin for control before bed time is increasing the Reg Insulin value through sleep. While making sure to check before meals This causes the blood sugars to drop while Dreaming the night away waking up in Insulin shock but Blood sugars are Normal 95mg\dl or above. - At 10:36 AM on Wed, Feb 15, 2006 Etie Moghissi,MD wrote:
Thank you for writing about this important issue,
For the most recent consensus statement( February, 2006) on this topic please visit www.aace.com
Etie Moghissi,MD
In February of 2006 I was hospitalized with what I thought was DKA (my blood sugar that morning was over 500 and I felt awful) so off to the ER we went. The attending doctor admitted me but said that I was not in DKA but had an infection. My white blood cell count was extremely high. Once I made it to my room I tried to explain to the nurse that I did carb counting with my meals and for every carb I counted covered with a ratio of insulin well they just could understand that. And when my meal tray came I could tell it was loaded with carbs. I made the nurse call the kitchen and find out exactly how many carbs were in that meal before I ate it. The nurse thanked me for explaining to her how carbs were counted in a diabetic meal and how it affected my blood sugar and covering the meal with insulin. I've been a brittle diabetic since the age of 3. I'm now 43.