Insulin errors and who gets insulin.

[nonethewiser]

Last few times in hospital I just told them that I'd manage my own diabetes, they were happy for me to do this but insisted on knowing what bg levels were before meals & what bolus dose was given, think it was just.to record in my notes.

Couldn't think of anything worse than leaving it to them if honest, more so now being on pump for last 15 years.

 

[helli]

Interestingly, the last time I was in hospital, they did not record my insulin dose. Maybe it was because I was not in overnight but I dod have GA.
I suspect their drug forms would struggle with things like suspending my basal because I was likely to go low before the surgery and probably with the corrections afterwards.
I wonder how they document HCL.
Or maybe they know the pump keeps track so that is good enough?

 

[Bruce Stephens]

I wonder how they document HCL.
Or maybe they know the pump keeps track so that is good enough?

I think the trend was towards letting Type 1 patients handle insulin themselves. I'd guess you're right that they'll just assume HCL is doing what it should be. I'd also guess that (so far) the numbers of people have been too low for them to have worked out any comprehensive policies, though I presume that'll have to change.

 

[JimG]

I agree but it is sometimes hard to explain that one understands one's own history best. I have a couple of stories, one of which involved my having to have the consultant override a doctor to enable me to obtain the correct treatment for an eye issue. As I said, the good ones listen.

 

[Amity Island]

You make a very good point @JJay. I have read a few posts in this thread and wondered whether the poster would have the same viewpoint if they were a "professional".

If they are a "professional" wouldn't that mean that they listen to the patient? I mean, surely the best way for doctors to effectively diagnose is to get as much information from the patient otherwise they are going in partially blind. I'd expect a professional to hear and listen to a patient. In terms of insulin doses, surely nobody knows this better than the patient? Unless of course they are in there because they can't manage their own condition. Or do the professionals just start the insulin from scratch without any input from the patient for those staying in hospital under their care?

I wouldn't have an issue with the professionals administrating the insulin, but I'd want it based on my timings, doses etc that I'd provide.

 

[Amity Island]

I agree but it is sometimes hard to explain that one understands one's own history best. I have a couple of stories, one of which involved my having to have the consultant override a doctor to enable me to obtain the correct treatment for an eye issue. As I said, the good ones listen.

I've got a few of my own too. The professionals at the pharmacy who issued me with a broken used insulin pen, on another occasion some half used box of humalog with one vial cloudy and cracked. I once had to argue with my g.p that I didn't want my tresiba pens issuing separately (I wanted a full unopened sealed box). Best one was telling the doctor about how unwell I was feeling and wanting to be seen in hospital, his reply was we don't admit type 2's to hospital!. I felt too ill to even tell him I'm type 1. And one of my g.p's often says they know nothing about treating diabetes.

 

[Amity Island]

The quality of healthcare is largely down to the individual who is dealing with you. It varies wildly from one professional to another.

 

[DaveB]

I always say I will do my own insulin when in hospital and have never had anyone argue that. Possibly as most occasions have been private hospitals. I tell them they can do finger-prick tests as often as they like or read my CGM with my phone.

 

[DaveB]

Yes it just goes to show how difficult the diabetes management we do day-in day-out really is. I’d imagine it may also include missed or delayed doses where food is brought to someone, but no one gives the dose (or it’s given late)?

The larger number of T2s taking insulin than T1s has been the case for some time I think. The relatively small proportion of T1s in the population of PWD means that only a fairly small proportion of T2s have to need insulin before they outnumber the entire T1 population!

Don't forget that many like me are listed as T2 when in fact are LADA i.e. effectively T1. I have always been slim and have the same insulin management problems as an 'official' T1. My C-peptide showed me just above the T1 threshold. Viruses can cause LADA, as they did in my case, and hence there will be no antibodies showing on antibody tests but the beta cell damage can be just as problematic.

 

[helli]

Viruses can cause LADA

It is often mentioned if this forum that viruses don’t cause Type 1. They trigger Type 1.
So, there is equal chance of the antibodies.
Type 1 is an autoimmune condition. If it was caused by a sudden shock, there would be no reason for the beta cells to recreate. It is the autoimmunity that stops beta cells from surviving with Type 1.

However, as also often mentioned on this forum, the non existence of antibodies does not rule out Type 1.

 

[Inka]

I always say I will do my own insulin when in hospital and have never had anyone argue that. Possibly as most occasions have been private hospitals. I tell them they can do finger-prick tests as often as they like or read my CGM with my phone.

That’s great if you’re reasonably ok and conscious but I would imagine many of the errors arise when people are quite ill, under anaesthetic, etc.

 

[DaveB]

It is often mentioned if this forum that viruses don’t cause Type 1. They trigger Type 1.
So, there is equal chance of the antibodies.
Type 1 is an autoimmune condition. If it was caused by a sudden shock, there would be no reason for the beta cells to recreate. It is the autoimmunity that stops beta cells from surviving with Type 1.

However, as also often mentioned on this forum, the non existence of antibodies does not rule out Type 1.

I might question some of this but I know there are generally quite rigid views on T1 and autoimmunity. Is there proof that viruses trigger T1 (i.e. beta cell death) rather than cause it? Why are so many 'T1/LADA' diagnoses not showing any antibodies? Might that not indicate that there isn't always autoimmunity as the cause but simply direct viral attack? Viruses attack many areas of the body and this isn't always called auto-immunity. My wife suffered an EBV virus attack following her kidney transplant resulting in a serious throat sore. The consultant didn't describe it as an 'autoimmune' attack.

 

[helli]

Why are so many 'T1/LADA' diagnoses not showing any antibodies? Might that not indicate that there isn't always autoimmunity as the cause but simply direct viral attack?

I am not a doctor or a scientist but my understanding is that there are multiple antibodies that can indicate Type 1 and not all are testable.

 

[Inka]

Type 1 is by definition auto-immune @DaveB Why didn’t you have antibodies? Two ideas - your LADA progressed slowly so by the time it was evident your antibodies had disappeared; or your diabetes is in a separate, perhaps unnamed yet, category to Type 1.

“In type 1 diabetes, your body has destroyed the insulin-producing cells in your pancreas – called beta cells - so you can't produce any insulin. This can happen over years. You may hear it called an autoimmune condition. That’s because the immune system that usually protects you against illness has done the opposite”

What causes type 1 diabetes?

Causes of type 1 diabetes It’s normal to wonder if something you’ve done could have caused your type 1 diabetes – or a child’s type 1 diabetes. But there’s nothing you could have done to prevent it.

www.diabetes.org.uk