A view from the other side ...

[foxl]

I have a friend in medicine -- a subspecialty -- who is dealing with a T1 pt who does not appreciate hospital attempt to keep her blood sugar in range, right now.

She is very frustrated b/c of course hospital control is not the same as patient-managed control. Because of what the patient has recently been through (ie stress hormones), she went hypo suddenly and they are just trying to keep her stable "enough," (meaning she is running somewhat high) to get her to where she can go home and be happy controlling her OWN blood sugars. But apparently the patient is not very pleased with what they are doing for her and is acting quite snotty. And told the doc she "injects to cover 'whatever' she wants to EAT." And is to put it delicately, not slender.

Anyhow my friend called me, knowing I would empathize (and I DO!), because, I know, while she does not know as much about different insulins as an Endo, she is not just stupid, either. Unfortunately by law it is up to the hospital to control our blood sugars, as inpatients, even when we better know how to manage it ourselves ...

Guess I am posting to say there are two sides to this ... and neither is fun to be on. It made me feel sad for both.

Stories? Thoughts?

[SueM]

In the UK anyone on insulin is encouraged to look after their own diabetes whilst in hospital. That is as long as they are well enough to do so. I certainly would not expect or want someone who knew nothing about me or my diabetes interfering with my control.

[jenb]

It must be frustrating for all!

Check out the recommended letter for hospitalized diabetics on Blood Sugar 101. I don't know if it would be honored everywhere, but it seems like a great idea and might be worth a shot (ha! - no pun intended).

Jen

[fairyblood]

she went hypo suddenly and they are just trying to keep her stable "enough," (meaning she is running somewhat high) to get her to where she can go home and be happy controlling her OWN blood sugars. But apparently the patient is not very pleased with what they are doing for her and is acting quite snotty. And told the doc she "injects to cover 'whatever' she wants to EAT." And is to put it delicately, not slender.

Wow- I have to say while I understand that there are too sides to every story in this case I can't see myself thinking any differently then this patient is. Just because you go low once doesn't mean it is a good idea to run higher. I would be really pissed if that was what a doctor wanted me to do. It is my body and I don't want to risk long term complications just because it is easier for you.

Hey and you know what people without diabetes eat what they want and are overweight too. Just because she has diabetes doesn't mean she should get more judgment for it. I am not saying that losing weight wouldn't be a good thing but as long as she has good control over her blood sugars it is up to her what she does or doesn't eat.

while she does not know as much about different insulins as an Endo, she is not just stupid, either.

Honestly I have been on almost every insulin out there and I know a lot about them. I really wouldn't assume that a doctor would necessarily know more then me. They might and many of them do but not all of them do.

I could be reading this situation completely wrong as I don't know the particulars at all. However a lot that is being said about her really strikes a nerve with me.

This is just how I read the situation. I could be off base.

[networkguy]

I believe as a T1, it is MY disease, and MY care. Do I occasionally need the assistance of a doc? OF COURSE! But I am the one managing my care, not my doc. I mentioned this on another thread, but just last year I had to go in for emergency appendectomy. Before I was put under, with the assistance of my wife I did a BS. Once I regained consciousness, the nurses were trying to manage my care (much to my disgust - trying to use regular instead of novolog among other things), and I had a discussion about it with them, and basically told them let me test on my own (every 90 mins) and correct according to MY needs (****, I'll even use my own stuff!), or I will promptly pull my IV out and walk out. Period. Begrudgingly she agreed.

I dont suggest this for everything. But Ive always been under the opinion its OUR disease, WE should manage it. Unless, of course, what we're doing doesnt work :p

[foxl]

It must be frustrating for all!

Check out the recommended letter for hospitalized diabetics on Blood Sugar 101. I don't know if it would be honored everywhere, but it seems like a great idea and might be worth a shot (ha! - no pun intended).

Jen


Yeah I have seen that letter. I suppose if it included a disclaimer about liability, they might buy it ... maybe.

I could absolutely see the pt's side of things ... except she refused to modify her eating after an injection, was asking for hourly BGs and corrections ... and most hospitals are not staffed for that. Heck I was on a RENAL unit and still got checked what, every 4 hrs, while on their insulin regimen?

I did blur some details of this situation since of course there is pt confidentiality -- heck, I did not get too much detail myself, except for my friend's feelings of helplessness and her frustration with the pt for not being willing to abstain from part of the carbs in her lunch ...

[foxl]

I believe as a T1, it is MY disease, and MY care. Do I occasionally need the assistance of a doc? OF COURSE! But I am the one managing my care, not my doc. I mentioned this on another thread, but just last year I had to go in for emergency appendectomy. Before I was put under, with the assistance of my wife I did a BS. Once I regained consciousness, the nurses were trying to manage my care (much to my disgust - trying to use regular instead of novolog among other things), and I had a discussion about it with them, and basically told them let me test on my own (every 90 mins) and correct according to MY needs (****, I'll even use my own stuff!), or I will promptly pull my IV out and walk out. Period. Begrudgingly she agreed.

I dont suggest this for everything. But Ive always been under the opinion its OUR disease, WE should manage it. Unless, of course, what we're doing doesnt work :p

WOW -- I do not think this pt would have done that, though maybe it would have been a relief for all concerned if she HAD.

[Grunch]

If the law determines that the hospital is responsible then they are correct in controlling her blood sugar and she just needs to accept that, as frustrating as it may be for her.

The patient should be allowed to choose to control his sugars and in that case the hospital shouldn't be responsible, but until the laws change the patient should accept it and stop whining.

[Subby]

I have a friend in medicine -- a subspecialty -- who is dealing with a T1 pt who does not appreciate hospital attempt to keep her blood sugar in range, right now.

She is very frustrated b/c of course hospital control is not the same as patient-managed control. Because of what the patient has recently been through (ie stress hormones), she went hypo suddenly and they are just trying to keep her stable "enough," (meaning she is running somewhat high) to get her to where she can go home and be happy controlling her OWN blood sugars. But apparently the patient is not very pleased with what they are doing for her and is acting quite snotty. And told the doc she "injects to cover 'whatever' she wants to EAT." And is to put it delicately, not slender.

Anyhow my friend called me, knowing I would empathize (and I DO!), because, I know, while she does not know as much about different insulins as an Endo, she is not just stupid, either. Unfortunately by law it is up to the hospital to control our blood sugars, as inpatients, even when we better know how to manage it ourselves ...

Guess I am posting to say there are two sides to this ... and neither is fun to be on. It made me feel sad for both.

Stories? Thoughts?

Seems to be completely lacking in understanding the situation of the type 1 here.

You have an excuse, never being insulin dependent and obviously not having been involved intimately with one so as to gain insight. But I think if your doctor friend can't better understand and have better empathy as to why a type 1 would be "snotty" about such a situation, they should probably find another job that doesn't involve contact with type 1 diabetics.

[foxl]

If the law determines that the hospital is responsible then they are correct in controlling her blood sugar and she just needs to accept that, as frustrating as it may be for her.

The patient should be allowed to choose to control his sugars and in that case the hospital shouldn't be responsible, but until the laws change the patient should accept it and stop whining.


Yeah I think one of the complications here is MD's and RNs in hospitals NEVER want to use the word legal with patients ... for fear of putting ideas into their heads. Who would want to invite a lawsuit, after all .... but if the patient is too young or ignorant to understand that aspect of the situation, why would they not act snotty to the doc?

[Grunch]

I see your point now. The hospital has to do their thing and it's also understandable that some patients will react like that out of ignorance. I guess if the hospital doesn't explain the legal implications to their patients then they are the ones in the wrong. The patient has the right to understand how things work.

The patient has to accept the situation only in the case where the hospital explains the legal implications of letting him do the control.

[foxl]

I see your point now. The hospital has to do their thing and it's also understandable that some patients will react like that out of ignorance. I guess if the hospital doesn't explain the legal implications to their patients then they are the ones in the wrong. The patient has the right to understand how things work.

The patient has to accept the situation only in the case where the hospital explains the legal implications of letting him do the control.

Heck, they never even explain why they put you in a wheelchair in order to discharge you ... they HATE bringing up the L word, ever.

[TommyC1]

Yup I'd be walking out of that hospital as fast as I could.
The only time I'd let anyone else dictate my management would be when I was completely incapacitated.
They think snotty is bad. They got no idea :evil:

[foxl]

Yup I'd be walking out of that hospital as fast as I could.
The only time I'd let anyone else dictate my management would be when I was completely incapacitated.
They think snotty is bad. They got no idea :evil:

OH ... but they DO. They do know. $$$$$

[georgepds]

...And told the doc she "injects to cover 'whatever' she wants to EAT." And is to put it delicately, not slender...

Not to be too cantankerous.. is there any possibility that the doc is assuming she's incompetent to mange her own care because she's obese?

The unspoken logic goes something like this.. one of the best things you can do to control diabetes is to loose weight, she obviously hasn't done the best thing she could, therefor she's incompetent.

That she covers what she eats suggests to me she knows what she is doing and has made a conscious attempt to control her own glucose response. That it is not the path that is "ideal" or the one the doctor would choose is not material. She's made a choice and is using the tools available to control the consequences of that choice.

At the limit let me pose the the question : would it be better if she did not inject to cover what she eats? In the short term (danger of hypo ) that's the case.. but it goes counter to what most of us have come to understand about the long term benefits of strict BG control

--G

[foxl]

Not to be too cantankerous.. is there any possibility that the doc is assuming she's incompetent to mange her own care because she's obese?

The unspoken logic goes something like this.. one of the best things you can do to control diabetes is to loose weight, she obviously hasn't done the best thing she could, therefor she's incompetent.

That she covers what she eats suggests to me she knows what she is doing and has made a conscious attempt to control her own glucose response. That it is not the path that is "ideal" or the one the doctor would choose is not material. She's made a choice and is using the tools available to control the consequences of that choice.

At the limit let me pose the the question : would it be better if she did not inject to cover what she eats? In the short term (danger of hypo ) that's the case.. but it goes counter to what most of us have come to understand about the long term benefits of strict BG control

--G

No, this is my friend, and she knows better than that -- it was that when asked to hold off on some of the carbs, the pt refused to do so.

[foxl]

I think some of the problem here is that the MD in this situation is frustrated b/c she is stuck complying with hospital policy too. Does that shed further light?

[TommyC1]

OH ... but they DO. They do know. $$$$$

Nah, $$$$$ would be the LEAST of their worries.:evil:

But I'd walk away long before I'd let them push me to that.

[jmrasmus]

ok let me put some perspective as far as why the pt might be injecting for the carbs she eats at lunch: hospitals in the US work on a sliding scale taking into account the BS of the pt and not the amount of food they consume. hospitals do not count carbs. you get an injection based on your bs, and then when it goes high bc you just ate you get another injection.

i was hospitalized and i was allowed to do my own care up until surgery and the next few hours after. They wanted to continue my injections for me, but when they put my "dinner" infront of me i asked for my injection. they checked my BS and it was 147, they said according to the written orders they could not give me any insulin until my BS went above 150... annoying but at that moment i insisted (politely) to speak with the resident in charge of my orders and had them changed to self care for the remainder of my stay.

There are pt's out there who are unwilling to control themselves, may be just ignorant to their situation, or at the end of the day just don't care. I have met all of the above.
If the pt is acting "snotty" and childish and medicating herself in hospital under the table I would certainly assume she is not mature enough to maintain herself on her own. I think if you act immature and childish you should be treated as a child. There is a way to go about taking care of yourself and a way to show you are responsible enough to do so.

[Joeprep4820]

I don't mind a hospital taking care of my BG when I'm hospitalized, but if that is the case, I want to meet the endocrinologist who is making the decisions. Most doctors aren't much more knowledgeable about diabetes if any more than we are. Why would I want someone who doesn't know what he is doing to take care of a crucial health aspect. I usually ask for the endocrinologist making the decisions, when and where he received his degree, and his transcripts from medical school. For nurses I'm a bit less worried, but I only allow nurses with 4 year degrees to be responsible for my care. If these conditions aren't met, I would rather take care of my own Diabetes care when hospitalized.

[jtausch]

Heck, they never even explain why they put you in a wheelchair in order to discharge you ... they HATE bringing up the L word, ever. I was in my own wheelchair and when I was discharged the last time i was in they had to push me out would not even let my wife do it.

[jmrasmus]

I don't mind a hospital taking care of my BG when I'm hospitalized, but if that is the case, I want to meet the endocrinologist who is making the decisions. Most doctors aren't much more knowledgeable about diabetes if any more than we are. Why would I want someone who doesn't know what he is doing to take care of a crucial health aspect. I usually ask for the endocrinologist making the decisions, when and where he received his degree, and his transcripts from medical school. For nurses I'm a bit less worried, but I only allow nurses with 4 year degrees to be responsible for my care. If these conditions aren't met, I would rather take care of my own Diabetes care when hospitalized.


you request his transcripts form med school? have you had any luck in ever getting those?
I'm not making fun of what you said but it sounds truely unrealistic, not to mention you really don't learn much in med school... it's the 6+ years you spend in residency that you leanr how to deal with pt's and how medicine really works

[Joeprep4820]

you request his transcripts form med school? have you had any luck in ever getting those?
I'm not making fun of what you said but it sounds truely unrealistic, not to mention you really don't learn much in med school... it's the 6+ years you spend in residency that you leanr how to deal with pt's and how medicine really works

I've received them via fax or email from each of my current doctors - GP, endo, and opthamologist. I figure I was requested to submit my official transcripts before I was hired for my current position, I feel I should see a doctor's before I hire him/her as my doctor. Of course I check out their experience and patient ratings as well.

[Moonglo]

I've received them via fax or email from each of my current doctors - GP, endo, and opthamologist. I figure I was requested to submit my official transcripts before I was hired for my current position, I feel I should see a doctor's before I hire him/her as my doctor. Of course I check out their experience and patient ratings as well.

Actually, my health insurance company even goes so far as to list the educational information for in network doctors on their provider list.