Self Management in Hospital

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JJay

JJay

Well-Known Member
Relationship to Diabetes
Type 1
I’ve had the misfortune to be in hospital for the past 4 weeks due to breaking my hip and collarbone in a fall, compounded by further surgery to remove a bowel obstruction. The first 3 weeks in a busy general hospital, excluding pre and post ops and 3 days I spent in intensive care, were fine as regards diabetes management - they were happy (actually grateful) for me take responsibility, all I had to do was report my BG and doses taken on each occasion.

I have now been transferred to a rehab facility in a community hospital, where they actually seem quite paranoid about the whole thing. I have signed a form agreeing to self manage, but apparently this has to be on their terms.

Firstly, I was told my kit (wallet with meter, Novorapid and Levemir pens) had to be kept in a locked cabinet, which I couldn’t access because my mobility is still very limited, and I would have to ask for it each time I wanted to inject. As an aside, this is a single room so there is minimal risk to other patients. I argued about this one and won.

This morning I’ve been told by the doctor that a) I must ask medical staff before altering my basal doses, and (b) that I must take my Levemir exactly 12 hours apart instead of at breakfast and teatime as I always have.

I don’t call this self-management. Does anyone have any ideas? Sorry for long post
 
So sorry to read about your fall and further surgery. Having your diabetes management taken away from you on top of this must be horrendous.
Thankfully, I have spent very little time in hospital but whenever I do, my diabetes management has been entirely down to me (apart from the finger pricking they did throughout the night one time).
I understand that the hospital is responsible for your medical care and may be concerned that this includes responsibility for any insulin dose mistakes you make. In the past, this meant that the ward would take our diabetes stuff away form us but I believe this is a very old fashioned approach.
Are you able to contact your DSN? They may be able to explain to the new ward on your behalf the importance of no locking away your supplies and give you back full control (including changing your Levemir timing and dose calculation).
The NICE guidelines may help especially this bit
Throughout inpatient admission, respect the personal expertise of adults with type 1 diabetes in managing their own diabetes and incorporate this into routine ward‑based blood glucose monitoring and insulin delivery.
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helli said:
So sorry to read about your fall and further surgery. Having your diabetes management taken away from you on top of this must be horrendous.
Thankfully, I have spent very little time in hospital but whenever I do, my diabetes management has been entirely down to me (apart from the finger pricking they did throughout the night one time).
I understand that the hospital is responsible for your medical care and may be concerned that this includes responsibility for any insulin dose mistakes you make. In the past, this meant that the ward would take our diabetes stuff away form us but I believe this is a very old fashioned approach.
Are you able to contact your DSN? They may be able to explain to the new ward on your behalf the importance of no locking away your supplies and give you back full control (including changing your Levemir timing and dose calculation).
The NICE guidelines may help especially this bit
Click to expand...
Thank you for this, I will certainly be referencing the NICE guidelines in my next conversation.

However, part of my problem is that I don’t have a specialist team or DSN, having been managed by my GP practice with occasional input from a “community diabetes team” for the past 25 years!

Saying that has given me an idea though - I will ask the hospital to contact the CDT. Shame it’s nearly the weekend!
 
I found that saying No very firmly helped a lot @JJay No explanation, just a firm No. if they persist, ask them to put their recommendations (re Levemir, etc) in writing and sign it, so you have it ready to sue them when things go wrong. You’ll find they backtrack extremely quickly. Or just say nothing and ignore them.
 
Really sorry to hear that you had a fall @JJay and that has resulted in such a long hospital stay. I hope that you make a speedy recovery now and are able to go back home soon.
It is my worst nightmare having someone try to take over my diabetes management, so I can entirely sympathise with the stress of the ongoing battle with the hospital staff. My Levemir doses change from day to day (well more night to night) depending upon what I have done and obviously illness and pain and inflammation will all tie into that in a hospital setting and I would not even trust a DSN to know how my doses need adjusting because only I know my body and how it responds to things. I also don't take my Levemir 12 hours apart except for a few weeks around the winter solstice each year when I need to bring my evening dose forward, but doing that at this time of year would also cause me problems and BG upheaval because my doses and the timing of them are set up to give me stable background cover.
I hope you are able to train the new hospital staff quickly to what you need, not what they think you should need. Grrr!
 
Inka said:
I found that saying No very firmly helped a lot @JJay No explanation, just a firm No. if they persist, ask them to put their recommendations (re Levemir, etc) in writing and sign it, so you have it ready to sue them when things go wrong. You’ll find they backtrack extremely quickly. Or just say nothing and ignore them.
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It seems their concern is being sued by my family should I be left to my own devices, get confused, and inject twice or something. We have agreed that I will wait 3 days before making any changes, notify the intended dose to the nurse in charge who will check with the doctor. It was clear that is the furthest they will budge.

I don’t really want to create a huge rift as the facility is superb in every other way - modern, wonderful staff, a very calm and laid back atmosphere, great physio support - even the food is more than halfway decent!

And on that note I’ve also been provided the means to access the carb count of the meals on offer. They said o-one had ever asked before
 
rebrascora said:
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It is my worst nightmare having someone try to take over my diabetes management, so I can entirely sympathise with the stress of the ongoing battle with the hospital staff.
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I honestly think if I was put in this position. I’d let “them” crack on with it & comply to the lockdown of my kit. That’s not to say I wouldn’t have a spare concealed kit handy (inclusive of hypo treatment.) should the sparks fly. 😉
 
Sorry, you have had a fall and I wish you better.
 
I find this kind of attitude intensely frustrating. :(

The hospital inpatient data about diabetes management in things like the National Diabetes Audit is awful. Busy ward staff are simply not equipped (and don’t have the time available) to cosset and coddle something so illogical, contrary and individual as T1 on an hour by hour (minute by minute!) basis.

And what on earth do they think you’ve been doing for the past 25 years??

It’s a crazy situation for you to be put in!

Get well soon!
 
everydayupsanddowns said:
I find this kind of attitude intensely frustrating. :(

The hospital inpatient data about diabetes management in things like the National Diabetes Audit is awful. Busy ward staff are simply not equipped (and don’t have the time available) to cosset and coddle something so illogical, contrary and individual as T1 on an hour by hour (minute by minute!) basis.

And what on earth do they think you’ve been doing for the past 25 years??

It’s a crazy situation for you to be put in!

Get well soon!
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I went in for an out patient procedure a while back, got tested at 4.5. Just prior. Told to hit myself with 70g of carbs? & they’d see me in an hour. I told them straight I’d do 10g & come test me in 20 minutes. That’s not even hypo. I could have tucked the ten & been ready for what’s happening. If not? Then give me that “hour.” Before you might ask. It was a basal low. Why not ask the patient & confirm they are confident in thier managment?
 
Sorry to hear about your fall and consequent hospital stay.

I am pleased that they let you self manage in the after care from ops, as per hospital protocols.
I found them very grateful that I was able to deal with this.

Although you are not under the diabetes team at the hospital that does not prevent them from contacting the team and giving you the chance to talk to them and agree a plan which they should then be able to get the nurses to follow.

Great that the rehab unit is so good in other ways. It is good that you have access to the carb info for the meal. Waiting to change your Levemir dose is sensible unless there are big changes in levels. Your basal needs will be different with the change in levels of activity, and managing the pain.

I know that the recommendation is 12 hours apart. When you do yours at breakfast and tea time, are these at the same time each day. I remember that I used to do breakfast and bedtime, not realising that the times needed to be consistent.

Let us know how you get on.
 
SB2015 said:
Sorry to hear about your fall and consequent hospital stay.

I am pleased that they let you self manage in the after care from ops, as per hospital protocols.
I found them very grateful that I was able to deal with this.

Although you are not under the diabetes team at the hospital that does not prevent them from contacting the team and giving you the chance to talk to them and agree a plan which they should then be able to get the nurses to follow.

Great that the rehab unit is so good in other ways. It is good that you have access to the carb info for the meal. Waiting to change your Levemir dose is sensible unless there are big changes in levels. Your basal needs will be different with the change in levels of activity, and managing the pain.

I know that the recommendation is 12 hours apart. When you do yours at breakfast and tea time, are these at the same time each day. I remember that I used to do breakfast and bedtime, not realising that the times needed to be consistent.

Let us know how you get on.
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I did suggest they contacted the Community Diabetes Team and the nurse took the details. I am reasonably ok with what’s been agreed - I would in any case have given each dose change at least 3 days to establish a pattern.

I realised that on my normal timetable, my Levemir doses would be more or less 12 hrs apart in any case, breakfast being around 8:00 and teatime around 7:30. But here it’s breakfast at 7:30 and tea at 5:00. It’s more convenient to do the basal at the same time as the bolus, but it’s no biggie to revert to “8 & 8” - I do have plenty of time on my hands at present
 
JJay said:
I did suggest they contacted the Community Diabetes Team and the nurse took the details. I am reasonably ok with what’s been agreed - I would in any case have given each dose change at least 3 days to establish a pattern.

I realised that on my normal timetable, my Levemir doses would be more or less 12 hrs apart in any case, breakfast being around 8:00 and teatime around 7:30. But here it’s breakfast at 7:30 and tea at 5:00. It’s more convenient to do the basal at the same time as the bolus, but it’s no biggie to revert to “8 & 8” - I do have plenty of time on my hands at present
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It sounds like the differences in management are not too big to deal with and that you are in a good place for your recovery. Rest well.
 
Probably for last 20 years managed my own diabetes whilst in hospital, usually staff are OK with this & just want to know insulin doses & bg readings.

Unless someone is incapable of managing their own diabetes in hospital then can't see what issue is, we manage our own condition 24/7 without any or little imput from outside.

Here's to a speedy recovery @JJay
 
Hope your on the mend and home again soon
 
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