Hospital Stay
I am 6 days RNY post op. I had an uneventful experience in the hospital as far as my surgery went...all except for...NOBODY WOULD GIVE ME INSULIN!!!
Being a Type 1, I had informed the hospital rep that attended my pre-op. She mentioned to me that she would not it and get the "Diabetes Team" involved. Thank God I did that.
When I left for the hospital Tuesday morning, my BS was 98. By the time they checked it when inserting IV etc, it had raised to 150 (stress). After surgery, I was 240. They gave me 1 unit of Humalog. I let them know that would never be enough but they advised that was what my Dr had ordered (per his scale). At midnight, they checked again and it was 340. This time they gave me 2 units of Humalog. I had what I believe was my first Panic Attack. They said they weren't going to give me Lantus. I wanted so bad to go to my purse and get my own insulin but I didn't want it to come down and them think their 2 units had done it. Luckily, 10 minutes later they said they had received a call advising them to give me my Lantus. The next morning, I met someone from the Diabetes Team who had called in to check on me the previous night. She listened to me and what I took pre-op and altered my orders. She even was an advocate for me to go home that day (no matter what my sugars looked like) because she knew I would monitor them better than the hospital was. They were checking my levels every 6 hrs and giving me amounts that didn't touch my levels. I was so disappointed in the way things were handled but felt my saving grace was that "Diabetes Team" that came to my rescue.
My advice to any Type 1's having surgery is to have a plan BEFORE you enter the hospital. Do not let your surgeon dictate your insulin dosages. The nurses acted like I was crazy and kept telling me how "normal" it all was. I know that it is but it was making me feel ill and I couldn't understand their take on things. I think they thought I was straight up crazy and were glad to see me leave, lol.
Being a Type 1, I had informed the hospital rep that attended my pre-op. She mentioned to me that she would not it and get the "Diabetes Team" involved. Thank God I did that.
When I left for the hospital Tuesday morning, my BS was 98. By the time they checked it when inserting IV etc, it had raised to 150 (stress). After surgery, I was 240. They gave me 1 unit of Humalog. I let them know that would never be enough but they advised that was what my Dr had ordered (per his scale). At midnight, they checked again and it was 340. This time they gave me 2 units of Humalog. I had what I believe was my first Panic Attack. They said they weren't going to give me Lantus. I wanted so bad to go to my purse and get my own insulin but I didn't want it to come down and them think their 2 units had done it. Luckily, 10 minutes later they said they had received a call advising them to give me my Lantus. The next morning, I met someone from the Diabetes Team who had called in to check on me the previous night. She listened to me and what I took pre-op and altered my orders. She even was an advocate for me to go home that day (no matter what my sugars looked like) because she knew I would monitor them better than the hospital was. They were checking my levels every 6 hrs and giving me amounts that didn't touch my levels. I was so disappointed in the way things were handled but felt my saving grace was that "Diabetes Team" that came to my rescue.
My advice to any Type 1's having surgery is to have a plan BEFORE you enter the hospital. Do not let your surgeon dictate your insulin dosages. The nurses acted like I was crazy and kept telling me how "normal" it all was. I know that it is but it was making me feel ill and I couldn't understand their take on things. I think they thought I was straight up crazy and were glad to see me leave, lol.
(deactivated member)
on 11/1/10 10:00 pm - Woodbridge, VA
on 11/1/10 10:00 pm - Woodbridge, VA
This is good info/advice for type 2s as well. I had high glucose levels the entire time I was in the hospital (I'm type 2), and they were giving me insulin, which I'd never had before and wasn't working. Come to find out, the geniuses hooked me up to a regular IV solution - you know, with SUGAR in it. No wonder the insulin wasn't doing much. Once I went home, shocker, my levels started coming back down. ASK A LOT OF QUESTIONS AND BE YOUR OWN ADVOCATE - the squeaky wheel gets the grease (or insulin or adjusted IV)!
I had a similar experience. When they were checking me in I told them that I was Type 1 and needed insulin regularly. When they checked my records everthing said I was Type 2, I just about flipped. Everyone was very good to me, but like yourself they didnt use the proper sliding scale to bring me down and I also had to keep telling them I needed Lantus. I had mine in my purse as well and almost took some. Eventually it worked out and they gave me some Lantus. I am so glad at a week post op that I have not had to put my pump back on and just started since leaving hosptial using Lantus morn and night.
I was just talking to my co-worker and with her Cancer she also has to remind everyone. We do so need to take care of ourselves as noone else is.
Wish you the best.
I was just talking to my co-worker and with her Cancer she also has to remind everyone. We do so need to take care of ourselves as noone else is.
Wish you the best.
Moving on to better health
Here's my experience.
I knew I needed a plan from my first visit with the surgeon who said I would have to go off my insulin pump when I started the pre-op diet. I did not say anything at that time, i had no intentions of going off my pump. I spoke to my endo who wrote a letter to the surgeon telling him I needed to stay on the pump. Since my surgeon required the letter from my endo, he shouldn't have brought up how my diabetes would be managed since it wasn't his area of expertise, He should have deferred to the endo from the beginning. If he had the following would not have happened.
At my second visit with the surgeon he was no longer saying I needed to go off the pump for the pre-op diet. Now it was just go off the pump when I was in the hospital. I asked him why? He started to give me an answer and then stopped in mid-sentence to say because he was the surgeon and he said so. I replied that answer just wasn't good enough.
Later he emailed me an apology. I emailed him back why I thought keeping the pump on was a good idea and how I had managed just fine during previous hospitalizations. I said I was willing to go off of it during surgery but wanted to use it before and after. He responded that we would let my endo help us manage my diabetes in the hospital. I had made sure my endo was available and I chose the hospital at which both my PCP and endo had privileges.
Fast forward to surgery day. Endo wrote orders for me to keep pump on through surgery and to manage my own diabetes once out of recovery. Although I was willing to take it off during surgery I kept it on because of the endo's orders.
Here's what happened. In the holding area outside of the OR, surgeon came and saw I had my pump clipped to my gown. He asked me what is that? Is that your pump? What rate is it at? I said 1.5 units/hr. He then said he didn't want it on during surgery and that it had to come off. At that point I was no longer going to fight the battle and make my surgeon angry right before he was about to cut on me. I took the pump off right after I was wheeled into the OR.
My Endo comes to the recovery room while I am still loopy from anesthesia and hooks the pump back up. She is pissed because my BG has gone up after just 1.5 hours without insulin. (Pumps deliver small amounts continuously of rapid acting insulin so there is no reserve or long acting insulin around to cover you once delivery is stopped). Once in a room
I begin managing my own BG. However my BG continues to rise. Then a nurse says it could be that sugar they are giving you in your IV. I was shocked because I had been told they don't give bariatric patients glucose in their IVs. Because the surgeon is so used to people's diabetes seming to disappear after surgery he orders dextrose in the IV for diabetics to help prevent hypoglycemia. My IV said in big letters Potassium Chloride and small letters underneath D5. I was getting about 6 gm/hr of dextrose. Nurse said it was just a small amount , not enough to make a difference. Maybe in a type 2 diabetic on pills or recently diagnosed who still makes plenty of insulin. I told her that was 144 gms/day, almost the 180 gms in my diabetic diet I had been prescribed by nutritionist CDE before my weight loss journey began that required 35 units of bolus insulin to cover. It's the sugar in the IV and the lack of sugar during surgery that caused my blood sugar to increase to 268. My blood sugars would continue to rise even more unless I increased my basal insulin to include enough insulin to match the 6 gm/hr of dextrose in my IV. I increased my basal rate .6 units/hr to cover the 6 gm dextrose and gave my self 9 units of correction insulin and brought my blood sugar down from 268 to 110. From then on my control was almost a straight line except right before I was being discharged.
Endo had left orders to be contacted if my BG went below 70 or over 250. I was testing my BG but the nursing staff was not recording the results in my medical record. Endo had to contact them and ask them where are my BG readings so she could view them remotely in my electronic medical record and keep an eye on them. Only then did the nursing staff start recording or paying attention to the results. (When I arrived I gave the nurse a sheet with my pump settings: my basal rates, my insulin/carb ratios, and my correction factors. She gave the sheet back to me. She didn't even want it.)
Just before discharge, my BG reading was 74. I said to the nurse I didn't want it to fall below 70 and would feel more comfortable with it just a little higher. I asked for 4 gms of sugar in liquid form since I'm on liquids and didn't want to take glucose tablets. Nurse replies she doesn't have any sugar free bariatric clear liquids to give me. Hello? Didn't I just ask for 4 grams of sugar? Then she said we have unsweetened apple juice but you're not allowed to have that. I had to convince her it was okay to give me the unsweetened apple juice she had available on the floor by showing her unsweetened juices diluted with water were allowed on the list of liquids the dietician had given me for the full liquid diet I would start as soon as I walked out of the hospital. Regardless of whether I'm allowed to have it or not, if I was having a low the nurse should know she can give me juice by mouth to correct a low if I am awake and able to ingest by mouth. If I was having a real low like a BG of 40 or 50 I wouldn't want a nurse to be standing around talking about we don't have any bariatric clear liquids on the floor. I'd just want her to act quickly to treat the low.
All of this from a hospital recognized by US News and World Report.
I knew I needed a plan from my first visit with the surgeon who said I would have to go off my insulin pump when I started the pre-op diet. I did not say anything at that time, i had no intentions of going off my pump. I spoke to my endo who wrote a letter to the surgeon telling him I needed to stay on the pump. Since my surgeon required the letter from my endo, he shouldn't have brought up how my diabetes would be managed since it wasn't his area of expertise, He should have deferred to the endo from the beginning. If he had the following would not have happened.
At my second visit with the surgeon he was no longer saying I needed to go off the pump for the pre-op diet. Now it was just go off the pump when I was in the hospital. I asked him why? He started to give me an answer and then stopped in mid-sentence to say because he was the surgeon and he said so. I replied that answer just wasn't good enough.
Later he emailed me an apology. I emailed him back why I thought keeping the pump on was a good idea and how I had managed just fine during previous hospitalizations. I said I was willing to go off of it during surgery but wanted to use it before and after. He responded that we would let my endo help us manage my diabetes in the hospital. I had made sure my endo was available and I chose the hospital at which both my PCP and endo had privileges.
Fast forward to surgery day. Endo wrote orders for me to keep pump on through surgery and to manage my own diabetes once out of recovery. Although I was willing to take it off during surgery I kept it on because of the endo's orders.
Here's what happened. In the holding area outside of the OR, surgeon came and saw I had my pump clipped to my gown. He asked me what is that? Is that your pump? What rate is it at? I said 1.5 units/hr. He then said he didn't want it on during surgery and that it had to come off. At that point I was no longer going to fight the battle and make my surgeon angry right before he was about to cut on me. I took the pump off right after I was wheeled into the OR.
My Endo comes to the recovery room while I am still loopy from anesthesia and hooks the pump back up. She is pissed because my BG has gone up after just 1.5 hours without insulin. (Pumps deliver small amounts continuously of rapid acting insulin so there is no reserve or long acting insulin around to cover you once delivery is stopped). Once in a room
I begin managing my own BG. However my BG continues to rise. Then a nurse says it could be that sugar they are giving you in your IV. I was shocked because I had been told they don't give bariatric patients glucose in their IVs. Because the surgeon is so used to people's diabetes seming to disappear after surgery he orders dextrose in the IV for diabetics to help prevent hypoglycemia. My IV said in big letters Potassium Chloride and small letters underneath D5. I was getting about 6 gm/hr of dextrose. Nurse said it was just a small amount , not enough to make a difference. Maybe in a type 2 diabetic on pills or recently diagnosed who still makes plenty of insulin. I told her that was 144 gms/day, almost the 180 gms in my diabetic diet I had been prescribed by nutritionist CDE before my weight loss journey began that required 35 units of bolus insulin to cover. It's the sugar in the IV and the lack of sugar during surgery that caused my blood sugar to increase to 268. My blood sugars would continue to rise even more unless I increased my basal insulin to include enough insulin to match the 6 gm/hr of dextrose in my IV. I increased my basal rate .6 units/hr to cover the 6 gm dextrose and gave my self 9 units of correction insulin and brought my blood sugar down from 268 to 110. From then on my control was almost a straight line except right before I was being discharged.
Endo had left orders to be contacted if my BG went below 70 or over 250. I was testing my BG but the nursing staff was not recording the results in my medical record. Endo had to contact them and ask them where are my BG readings so she could view them remotely in my electronic medical record and keep an eye on them. Only then did the nursing staff start recording or paying attention to the results. (When I arrived I gave the nurse a sheet with my pump settings: my basal rates, my insulin/carb ratios, and my correction factors. She gave the sheet back to me. She didn't even want it.)
Just before discharge, my BG reading was 74. I said to the nurse I didn't want it to fall below 70 and would feel more comfortable with it just a little higher. I asked for 4 gms of sugar in liquid form since I'm on liquids and didn't want to take glucose tablets. Nurse replies she doesn't have any sugar free bariatric clear liquids to give me. Hello? Didn't I just ask for 4 grams of sugar? Then she said we have unsweetened apple juice but you're not allowed to have that. I had to convince her it was okay to give me the unsweetened apple juice she had available on the floor by showing her unsweetened juices diluted with water were allowed on the list of liquids the dietician had given me for the full liquid diet I would start as soon as I walked out of the hospital. Regardless of whether I'm allowed to have it or not, if I was having a low the nurse should know she can give me juice by mouth to correct a low if I am awake and able to ingest by mouth. If I was having a real low like a BG of 40 or 50 I wouldn't want a nurse to be standing around talking about we don't have any bariatric clear liquids on the floor. I'd just want her to act quickly to treat the low.
All of this from a hospital recognized by US News and World Report.
This Is a terrible story!
I'm a type 1 diabetic ( over 20 years) and a Medtronic pump user for the last 5. I'm in the pre op faze of preparations for the vertical sleeve operation, I hope! Your story raised many questions which I, stupidly, didn't consider to ask. I'll now!
Thank you for sharing your hospital experience.
I need some time to digest this info and make my own list of questions for my medical team in the hospital.
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