Meal times in hospital.

[PaulG]

At home I try to eat small meals at regular intervals. Breakfast (porridge) 0630, light lunch 12.30, main meal ( a potato green veg bit of chicken breast etc) 18.30, and maybe a cream cracker & cheese at 23.00 . Just examples you understand.
I've just had 8 days in a respiratory ward with a lung problem. Out today. 3 Meals:- Breakfast 09.30 Lunch at 13.00, Supper at 18.30.
Couldn't fault the food, just the timing. Potential low sugar level at 04.00. I went to no end of trouble to try to explain that regular intake of food is no different for a diabetic than for drugs, my insulin jabs at 06.15 and 18.15 for instance. A simple 4 1000mg paracetamol per day would be every 6 hours. This hospital has a Diabetic Unit which I visit every 6 months. I suggested they pick up the phone and confirm my request but nooooo. Got there in the end.
Regards, Paul G

 

[Inka]

I hope your lung condition is improving @PaulG What insulin do you take? Is it a mixed insulin? If so, you should have received help to change your morning injection time so it was closer to breakfast.

 

[Lucyr]

At home I try to eat small meals at regular intervals. Breakfast (porridge) 0630, light lunch 12.30, main meal ( a potato green veg bit of chicken breast etc) 18.30, and maybe a cream cracker & cheese at 23.00 . Just examples you understand.
I've just had 8 days in a respiratory ward with a lung problem. Out today. 3 Meals:- Breakfast 09.30 Lunch at 13.00, Supper at 18.30.
Couldn't fault the food, just the timing. Potential low sugar level at 04.00. I went to no end of trouble to try to explain that regular intake of food is no different for a diabetic than for drugs, my insulin jabs at 06.15 and 18.15 for instance. A simple 4 1000mg paracetamol per day would be every 6 hours. This hospital has a Diabetic Unit which I visit every 6 months. I suggested they pick up the phone and confirm my request but nooooo. Got there in the end.
Regards, Paul G

What do you mean by potential low sugar, did you test or not? If you tested and were low they should have supplied dextrose tabs or juice to correct it.

 

[PaulG]

I hope your lung condition is improving @PaulG What insulin do you take? Is it a mixed insulin? If so, you should have received help to change your morning injection time so it was closer to breakfast.

Hi Inka. I use a Humulin Kwik Pen, 30 soluble / 70 isophane. 36 units @ 06.30 and 36 @ 18.30. The injections I've done probably runs into thousands. As the saying goes, "more pricks than a second hand dart board". They still don't let me fill or prime the pen myself, instead an unqualified nurse does it and then has to get it signed for by a higher qualified person who hasn't watched, as its a controlled drug. They prime in the horizontal to remove air instead of holding the pen vertical. Then its passed to me and I inject it anyway. You couldn't make it up.
My point is that I can't go from 18.30 till 08.30, 14 hours, without something.
For the first three days I had my visitors smuggle sandwiches in, finally persuading a nurse to order one each day under a false name and hide it in the office fridge, passed to me after midnight.

Haven't been able to lay down on my back for weeks.
Just had the bestest shower and nights kip ever, got up and made a proper cuppa.
Paul G

 

[PaulG]

What do you mean by potential low sugar, did you test or not? If you tested and were low they should have supplied dextrose tabs or juice to correct it.

Hi Lucyr
I was testing half a dozen times myself plus the hospital times, usually the wrong times.
By law if I drive I must carry a finger prick device and correction method. e.g. dextrose tabs but they work quickly and fade quickly too. Prefer a round of bread as its slow release carbs.
Prevention is better than cure. By eating the midnight sandwich snack I know I'll be ok though the 14 hours and test as 6.0 ( ish ) before breakfast.

Paul G

 

[Inka]

Hi Inka. I use a Humulin Kwik Pen, 30 soluble / 70 isophane. 36 units @ 06.30 and 36 @ 18.30. The injections I've done probably runs into thousands. As the saying goes, "more pricks than a second hand dart board". They still don't let me fill or prime the pen myself, instead an unqualified nurse does it and then has to get it signed for by a higher qualified person who hasn't watched, as its a controlled drug. They prime in the horizontal to remove air instead of holding the pen vertical. Then its passed to me and I inject it anyway. You couldn't make it up.
My point is that I can't go from 18.30 till 08.30, 14 hours, without something.
For the first three days I had my visitors smuggle sandwiches in, finally persuading a nurse to order one each day under a false name and hide it in the office fridge, passed to me after midnight.

Haven't been able to lay down on my back for weeks.
Just had the bestest shower and nights kip ever, got up and made a proper cuppa.
Paul G

Unless you were totally incapacitated, they should have let you do your own injections. I’m sure there was a policy about this some years ago. @everydayupsanddowns might know as Diabetes U.K. we’re probably involved.

I always take my own glucose and snacks into hospital as it saves the worry. If you usually have a bedtime snack, you should have been given one. My concern is you injecting for breakfast at 6.30am or whatever and not eating breakfast until 9.30am. I’d have hoped they knew enough to not let you do that as you could have had a hypo.

 

[Inka]

Found something:

Self-management in hospital

And

Here in more detail

.

 

[PaulG]

Unless you were totally incapacitated, they should have let you do your own injections. I’m sure there was a policy about this some years ago. @everydayupsanddowns might know as Diabetes U.K. we’re probably involved.

I always take my own glucose and snacks into hospital as it saves the worry. If you usually have a bedtime snack, you should have been given one. My concern is you injecting for breakfast at 6.30am or whatever and not eating breakfast until 9.30am. I’d have hoped they knew enough to not let you do that as you could have had a hypo.

I hear what you say but for those few days I would try to arrange it nearer the mealtime; or, save the afternoon snack of pack of three digestives for emergencies. They used to lock my pen away and unlock and prime only when the drugs trolly came round, WHATEVER time that happens to be.
Funny, but although they would lock the pens away, on the morning of the day I was due out they gave me three pens even though I said I had six in the fridge at home.

 

[Inka]

There’s a lot of ignorance about insulin use @PaulG They locked my pens in the cupboard by my bed but gave me the key when I forced them to. It can cause a lot of stress, I know, because it’s like they take all your personal control away from you. I had to be quite forceful - which obviously no-one should have to do when they’re not feeling well.

If you’re up to it, it might be worth sending an email to the hospital, ward, diabetes team, and management making numbered suggestions of how they could improve care for people with diabetes. I’ve heard some awful stories from friends on insulin.

 

[Sally71]

Unfortunately general ward staff have little knowledge of diabetes and insulin use and it can be a bit of a minefield. Either they are completely over-zealous and think you don’t have a brain at all and they know it all, or they are completely clueless and it all becomes a bit random. My mum was in hospital with a broken hip a few years ago, one night they wouldn’t give her her Levemir in the evening because the doctor had gone home, despite my mum’s protestations that she would be really high without it, they seemed to think it would be ok. Then surprise surprise, the next morning her blood sugar was in the 30s and they had to hastily get her on an insulin drip! Last year when she had pneumonia she was in a different hospital who managed it a lot better, they let her do things herself as long as they wrote everything down. She was complaining to me that she kept waking up hypo in the morning and couldn’t understand why. I suggested reducing the Levemir by a unit to see what happened. Which she did, and woke up with a perfect 6 the morning after, but the nurse got quite stroppy that she’d dared to reduce her dose by a whole unit without consulting anyone! How on earth these people think we manage from day to day when we aren’t in hospital, I have no idea!

 

[Lucyr]

Clearly you weren’t driving whilst staying in hospital so that’s irrelevant. Did you actually keep having hypos at 4am or not? You said potential hypos at 4:00. What I can’t work out is whether you kept actually having hypos then or you’re concerned that you might do. If you weren’t having a hypo every night then it’s a non issue. If you were and they wouldn’t give you any dextro to treat them then that’s an issue.

Hi Lucyr
I was testing half a dozen times myself plus the hospital times, usually the wrong times.
By law if I drive I must carry a finger prick device and correction method. e.g. dextrose tabs but they work quickly and fade quickly too. Prefer a round of bread as its slow release carbs.
Prevention is better than cure. By eating the midnight sandwich snack I know I'll be ok though the 14 hours and test as 6.0 ( ish ) before breakfast.

Paul G

 

[everydayupsanddowns]

They still don't let me fill or prime the pen myself, instead an unqualified nurse does it and then has to get it signed for by a higher qualified person who hasn't watched, as its a controlled drug. They prime in the horizontal to remove air instead of holding the pen vertical. Then its passed to me and I inject it anyway. You couldn't make it up.
My point is that I can't go from 18.30 till 08.30, 14 hours, without something.

Gosh @PaulG that sounds like they made almost everything about your meals and insulin doses as inconvenient and difficult as possible!

Is it any wonder that the stats for inpatient stays for people with diabetes who use insulin make for such frightening reading!

One of my main recollections of using mixed insulin was how everything had to fit with the timing of the insulin!

If you felt able to, I think it would be worthwhile sending feedback to the hospital about your experiences, and how unnecessarily difficult it made things for someone who manages their injections at home without any assistance.

I’d suggest perhaps copying-in the hospital diabetes team, who I’m sure would be interested in hearing your experiences, and the anxiety it caused you.

 

[Lucyr]

My point is that I can't go from 18.30 till 08.30, 14 hours, without something.

If you can’t go 14 hours without eating then you need to sort out your insulin or your insulin doses. You should be fine to not eat during those times without any bg issues. Why not change your doses or ask to switch to a better insulin regime as seems your current one isn’t working for you?

 

[helli]

If you can’t go 14 hours without eating then you need to sort out your insulin or your insulin doses. You should be fine to not eat during those times without any bg issues. Why not change your doses or ask to switch to a better insulin regime as seems your current one isn’t working for you?

Is this the case when on a mixed insulin dose?
My understanding (based on personal experience 20 years ago) is that it requires a relatively strict meal schedule as each injection (taken twice a day) includes both fast and slow acting insulin.

I agree a basal bolus insulin regime would provide far more flexibility and allow 14 hours or more without eating. It was a relief for me when I transitioned. But when the OP is in hospital and dealing with other medical issues, does not sound like the ideal time for this if they wanted to.

 

[Lucyr]

Is this the case when on a mixed insulin dose?

That’s why I said or switch to a better insulin regime. It’s clearly causing OP anxiety to deviate from their routine, but they haven’t actually clarified whether they have hypos when they miss the snack or whether they are just nervous of having them. So they need to know that there are options to try either a lower dose or a different insulin.

Also, they aren’t in hospital any more so would be a good time to sort out their diabetes whilst home again. Good blood sugars will help recovery.

 

[PaulG]

I have printed your self management sheet out and will take it to my Diabetic Unit appointment which just happens to be on the 17th October. Thanks.

However She was the one that that when first starting to inject had my driving licence taken away from the day before Christmas till first week in Feb. Nearest supermarket 7 miles away and no busses in this neck of the woods. When I got it back they had only taken off 14 seater minibus.

Gosh @PaulG that sounds like they made a.most everything about your meals and insulin doses as inconvenient and difficult as possible!

Is it any wonder that the stats for inpatient stays for people with diabetes who use insulin make for such frightening reading!

One of my main recollections of using mixed insulin was how everything had to fit with the timing of the insulin!

If you felt able to, I think it would be worthwhile sending feedback to the hospital about your experiences, and how unnecessarily difficult it made things for someone who manages their injections at home without any assistance.

I’d suggest perhaps copying-in the hospital diabetes team, who I’m sure would be interested in hearing your experiences, and the anxiety it caused you.

@everydayupsanddowns

It didn't stop there. I'm on Ramipril 5mg twice a day for blood pressure & heart.
On the second morning the drugs wagon didn't have 5mg but did have 2.5's, so they gave me TWO. OK fair enough.
That evening I asked "Ramipril" ??? "You had TWO this morning so you can't have any more."
Woke up in the morning with a pulse of 193. Same the next day. Woke with a pulse of 196.
(measured on my own oximeter which I bought to keep check on my lung problem)

One more thing. I asked the male nurse looking after D section of the ward, myself and 6 others, how long he had been a nurse. He replied, "Three months. I used to be a land surveyor."

Paul G



edit to add:- Won't bother to report. Like MP's they all stick together and treat patients like fools anyway.