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Treatment in hospital and not eating

R

Radders

Well-Known Member
Relationship to Diabetes
Type 1
Has anyone any knowledge of what is meant to be happening in my situation please? I am in hospital under treatment for a bowel obstruction. I haven’t eaten for 8 days. In the first 6 days I was setting a 200% basal on my pump just to keep my levels under 10.
I had a procedure on Tuesday & since then I’m struggling to keep my levels above 4. My Libre is annoyingly unreliable at low levels.
My concern is that I can only assume that I’ve exhausted my liver’s supply of glucose which is why my levels keep dropping. I have reduced my basal rate and obviously am not doing any exercise.
Should the hospital be giving me something to replenish my liver? If so what?
 
I am afraid I cannot offer any direct help as I have no experience of the impact of type 1 but I have quite a bit of experience of undergoing surgery. A few years ago I was in hospital for bowel and liver operation. I have made a couple of comments about my issues when I was on an IV. These resolved when I could speak to the medical staff. In every subsequent visit for further operations the healthcare assistants or nurses monitored my blood sugars regularly. They should do that for you and, although they won't be specialists in diabetes, they should know about reporting abnormal levels. If you are worried you should speak to the doctors and ask to speak to a diabetes specialist and a dietitian.
 
I think you should have a glucose drip up. I can’t remember what they did for me when I was being induced, but I had glucose and saline I think. They turned the glucose up and down as needed. I kept my pump on so I had insulin. The glucose was hardly needed but it was up as a precaution. I’m not sure how that all worked because I was busy with other things, but they were clearly following a procedure.

I’m pretty sure Diabetes Teams are notified if one of their clinic patients is admitted. I had a DSN visit me. If nobody has been to see you, ask for a DSN or Diabetes consultant.
 
JimG said:
I am afraid I cannot offer any direct help as I have no experience of the impact of type 1 but I have quite a bit of experience of undergoing surgery. A few years ago I was in hospital for bowel and liver operation. I have made a couple of comments about my issues when I was on an IV. These resolved when I could speak to the medical staff. In every subsequent visit for further operations the healthcare assistants or nurses monitored my blood sugars regularly. They should do that for you and, although they won't be specialists in diabetes, they should know about reporting abnormal levels. If you are worried you should speak to the doctors and ask to speak to a diabetes specialist and a dietitian.
Click to expand...
Thank you. I’m just a bit concerned at the lack of understanding I’ve so far observed.
Inka said:
I think you should have a glucose drip up. I can’t remember what they did for me when I was being induced, but I had glucose and saline I think. They turned the glucose up and down as needed. I kept my pump on so I had insulin. The glucose was hardly needed but it was up as a precaution. I’m not sure how that all worked because I was busy with other things, but they were clearly following a procedure.

I’m pretty sure Diabetes Teams are notified if one of their clinic patients is admitted. I had a DSN visit me. If nobody has been to see you, ask for a DSN or Diabetes consultant.
Click to expand...
The doctor was quite insistent on my removing the pump. When I expressed anxiety about my care she said it was all set out in legal terms - so that’s ok - if anything goes wrong I can sue someone
 
Sorry to hear about your worries during in patient care @Radders

Hopefully the interruption to your pump therapy will only be short lived during the procedure (will you be under GA?). In patient care is a pretty scary prospect for those of us on insulin - especially with the number of insulin errors that are documented. I hope you can get back to managing your own diabetes very speedily, and that the op goes well.
 
@Radders I found a lack of understanding too. If they’ve removed your pump, are you on a sliding scale? If so, do watch them with that as they apply a formula which isn’t correct for everyone, ie you might be more insulin sensitive than their general person.

Please do request to see a DSN. I hope things improve for you soon.
 
everydayupsanddowns said:
Sorry to hear about your worries during in patient care @Radders

Hopefully the interruption to your pump therapy will only be short lived during the procedure (will you be under GA?). In patient care is a pretty scary prospect for those of us on insulin - especially with the number of insulin errors that are documented. I hope you can get back to managing your own diabetes very speedily, and that the op goes well.
Click to expand...
Thank you for your understanding. Yes I’ll be under GA. I had a brief procedure under GA on Tuesday and just kept the pump running- nobody even brought it up. But at that stage my levels were running high so perhaps that was my fault for not mentioning it as I didn’t feel under any great risk.
The op I’m having tomorrow isn’t a very long one but they want to start a “sliding scale” at some time during the early hours of the morning for some reason.
Thank you for your good wishes.
 
Inka said:
@Radders I found a lack of understanding too. If they’ve removed your pump, are you on a sliding scale? If so, do watch them with that as they apply a formula which isn’t correct for everyone, ie you might be more insulin sensitive than their general person.

Please do request to see a DSN. I hope things improve for you soon.
Click to expand...
I haven’t removed it yet - it turns out that it’s the nursing team who are in the night shift that are managing that, which I suppose gives them time to sort things out.
I just wish it wasn’t happening in the small hours as there’s no chance of getting to speak to any specialists now.
 
I really feel for you @Radders
I've had treatment for a couple of bowel obstructions over the last few years. The first time I was on MDI and the second on a pump.
I was on a sliding scale after surgery both times.
The first time I hadn't eaten for well over a week and had to ask them for feed (it was a bit complicated because they sent me home thinking it had resolved and I was readmitted the following day). If you're having a procedure tomorrow then I'd hope the issue with food will be resolving fairly soon.
As others have said keep an eye on your blood sugars when on the sliding scale.
If you're able to talk to someone before the scale is set up that would be really useful. The last scale I had was set up with the lowest value of 4. There was a lack of understanding that if blood glucose was 4 and the sensor showed that glucose was falling that leaving me on 0.5 units of insulin an hour was not a great idea!
If you're able to ask for a higher minimum level that would be great. If not keep your sensor alarms on and keep checking.
Hope all goes well tomorrow and that everything resolves.
 
Sorry, me again. Just tried googling sliding scale insulin therapy and nothing I found is relevant to me. Could someone please explain how it’s supposed to work so I can ask the right questions?
 
soupdragon said:
I really feel for you @Radders
I've had treatment for a couple of bowel obstructions over the last few years. The first time I was on MDI and the second on a pump.
I was on a sliding scale after surgery both times.
The first time I hadn't eaten for well over a week and had to ask them for feed (it was a bit complicated because they sent me home thinking it had resolved and I was readmitted the following day). If you're having a procedure tomorrow then I'd hope the issue with food will be resolving fairly soon.
As others have said keep an eye on your blood sugars when on the sliding scale.
If you're able to talk to someone before the scale is set up that would be really useful. The last scale I had was set up with the lowest value of 4. There was a lack of understanding that if blood glucose was 4 and the sensor showed that glucose was falling that leaving me on 0.5 units of insulin an hour was not a great idea!
If you're able to ask for a higher minimum level that would be great. If not keep your sensor alarms on and keep checking.
Hope all goes well tomorrow and that everything resolves.
Click to expand...
As I’ll be under GA I won’t be able to monitor my Libre alarms unfortunately. I’m worried that the nurse seems to be going to set all this up based on information the doctor has put on the computer, and both without any reference to me. My diabetes isn’t looked after at this hospital so nobody has any knowledge of my insulin sensitivity so there seems a lot of scope for things to go wrong.
 
Radders said:
Sorry, me again. Just tried googling sliding scale insulin therapy and nothing I found is relevant to me. Could someone please explain how it’s supposed to work so I can ask the right questions?
Click to expand...

They infuse insulin (and possibly glucose too) via a drip thing that looks like a huge insulin pump. They have a chart and adjust the rate of insulin based on your blood sugar and by what their chart says @Radders
 
@Radders How long will your op be? I asked if I’d have to take my pump off if I needed an emergency C section and was told possibly not because it was a short op.

For the sliding scale, what you could do is tell them your total basal and maybe give a list of your hourly basal rates. That way they’d have an idea of your normal needs.
 
You have a cannula in your arm attached to a device which has a syringe containing insulin. They will check your blood glucose and use the value to decide whether to change the amount of insulin that is being given. They will decide on a suitable range (eg between 4 and 8). If you are too low they reduce/stop the insulin, too high and they increase it. There is also a glucose drip attached.

For me a level of 4 is too low when I'm not well.
You'll be closely monitored during the operation and until you come round. I'd make sure that your alarms are on when you're back on the ward.

Hope all goes well.
 
Thank you everyone for your input. It was a difficult situation but eventually a diabetes nurse got involved and wrote a new insulin protocol for me which better reflected my insulin sensitivity.
I managed to fall out with a couple of the ward nurses in the process which wasn’t very nice but as I was on a different ward after the op it didn’t have an effect on my subsequent care.
My lesson learned is that we can’t ever assume that systems will work right for you and need to be hugely proactive in our care.
Thanks again, the insights and advice mentioned made all the difference.
 
Radders said:
Thank you everyone for your input. It was a difficult situation but eventually a diabetes nurse got involved and wrote a new insulin protocol for me which better reflected my insulin sensitivity.
I managed to fall out with a couple of the ward nurses in the process which wasn’t very nice but as I was on a different ward after the op it didn’t have an effect on my subsequent care.
My lesson learned is that we can’t ever assume that systems will work right for you and need to be hugely proactive in our care.
Thanks again, the insights and advice mentioned made all the difference.
Click to expand...

Glad you managed to get it sorted in the end @Radders
 
I hope you are now on the road to recovery after your surgery and will be allowed home soon but not before you are ready.
 
Glad to hear that you got the insulin protocol sorted @Radders
Wishing you a speedy recovery.
 
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