Tuesday, March 17, 2009

Planet Diabetes: Survival: Hospital

(a Dlife video on this subject)

Monday evening the husband and I went to a D-talk entitled "Being Insulin Dependent in the Hospital." Not that unusual,I mean, there are many such topics of conversation being revisited all around the country, ad nauseum, at various pump group meetings. This place...was at a location I've never been to(some other D-group, not pump specific) and the guest speaker was a type 1 endocrinologist himself. With such a resume I could hardly NOT go, it was like being written a blank check to the secrets of the universe. (or at least to the hospital) I needed the hubby to come with me because #1 he was interested and #2 he's been to the general location and can therefore find the place much better then myself. Finding out what makes a hospital + the rulers therein tick would be more then beneficial in the future. Plus I figured I could get some questions of my own answered...beyond the generic "you may want to change x-y-z" material.

The meeting room was small..and decidedly packed with PWD of all sorts and sizes. After the "Hi, I'm x and I've had diabetes for x years"(personally referring to myself as a diabetic still leaves an incredibly sour taste in my mouth and I rarely do it) intros the endocrinologist, sporting a Dexcom and Ping pump(bonus points for him!) launched right into the discussion.

The meeting lasted about 2 hours and was not boring at all. Riveting talk/discussion, despite one or two individuals periodically launching off on some completely irrelevant topic then the one on hand which one couldn't exactly prevent/say something about because we're all there to support each other and sit through 10 minute rants on insurance not covering lancets.(for real-who complains about that??there are so much more worthy things to complain about) If you have a guest speaker, I think its pretty rude NOT to keep the questions to the topic of discussion. But anytime you have a physician and laypeople you are going to get
someone reciting their entire medical history as they ask their question. Everyone suffers through it.
And I managed to learn some stuff:

-you always have the right to refuse the sliding scale and stay on the pump but if you're going into emergency surgery just give it up and resume when able. Emergency surgery, you should just shut up and be grateful if you make it out alive.(plus they tend to give some real whack-you-out drugs in emergency surgery) Elective surgeries...ALWAYS insist on pumping and if the surgeon doesn't like it find a new surgeon. In the ICU they check bgs so often that being on a insulin drip is the best way to go because you're drugged up and not able to make insulin decisions. Sliding scale anywhere=EVIL and under no circumstances should you be on one because its given according to the staff's schedule, not to your needs. People die of hypoglycemia IN THE HOSPITAL on a regular basis, and you sure don't want to be that person. Give insulin, recheck patient 6 hours later and they are dead because lunch was an hour late and they were too out of it to eat their lunch. Get the doc to write testing orders every 2-4 hours,or whenever necessary.

-most surgeons are not sadistic hellions intent on inflecting as much inconvenience as possible, they are just uninformed. So says an endocrinologist. Um-I think I'll have to take a rain check on that one, guess I haven't yet met the "nice" type of surgeon.

-Always bring your own lancing device(+ meter) ,never consent to their gullitine near your fingers. Much less painful with own lancing device.

-saw several graphs documenting the 6x rate of complications/death from 200+ post operative bgs, even in people who don't have diabetes. (steroids can do marvelous things to the bg) Freaky scary.

Bolused about five times that evening, bgs remained stuck in the mid 200's.It always makes me feel guilty, being at a D meeting and being high(as a pumper you should have the problem licked in about 1.5 hours) Definably need a basal overhaul. He also talked about all the changes they've made to their program and I was impressed(the power of a type 1 endo in bringing about REAL change for all the PWD in the hospital. They are going to have studies of intravenous CGM's in ICU patients.(since that is the most frequent setting for extreme hypoglycemia). The takeaway message was...communicate with the caregivers, call your endo if need be(doesn't work, but nice in theory),advocate for the basics of care. Because you're worth it.

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