When you are in the hospital and on a pump,are those in the hopital well educated about it ? The doctors,nurses etc...thanks...
~LONG
generally speaking, no. most staff know little - to - nothing about a pump and insulin.
I had my appendix out last Friday morning - here's how it went: I go to the ER with abdominal pain and needed a CAT scan with contrast. no worries, no one even cared I was on the pump yet. Then the results come in and I need to get admitted to get my appendix out. My first discussion are with the admitting staff and my current medications. It’s important to say, Insulin – via PUMP. This goes into your record and believe it or not, most doctors will leave your current meds alone, including your delivery. By telling them you are on a pump early, it goes on the record and it becomes “gospel”. Very few people will have an opinion or tell you to take it off, once it is in your record.
I stupidly left my meter in the truck, so I was at the staff mercy regarding finger sticks. When I asked, however, they were nice enough to come over and stick me. Things were going well, but I was fasting for over 14 hours and I went from 80’s to about 61 – and this began my first round of “lessons”. I told the ER nurse to bring me carbs, like a 4 gram glucose tab, they didn’t have any. I was due to go into surgery, so I couldn’t have fruit or juice. The best solution was to go on a dextrose IV. Now I asked and the staff told me there was 5g dextrose per 100ml saline – so I kindly asked for 200 ml. I had to demand to be taken off the dextrose bag, those do-do heads would have left me on the bag and I would have had a bs of a zillion. The next test right before surgery was 130, and I thanked the nurse who switched my IV bag back to saline and said “see – Perfection”! If had not intervened I would have been left on dextrose.
The anesthesiologist and I had a nice talk. I said – If you are planning on taking me off the pump I will refuse treatment. She was very knowledgeable regarding insulin and agreed that I could keep the pump on and I would NOT get the dextrose bag, but she wanted a lower than normal basal rate. I lied and told her the lowest I could go was 50%.
In recovery I had my biggest issue, the dumb-a$$ attending physician was a 2nd year resident, menaing she had very little experience. She wanted my pump off because “I wasn’t eating so I didn’t need it”. I gave her a short lesson in Type 1 and basal insulin requirements, since she was sooo much smarter than me she barely listened. Then she glanced at my IV and informed me I was on the dextrose drip. The bag was way behind me – so I couldn’t read it myself! I sat up on the stretcher and said I wanted everyone in the recovery area front and center for a severe beating. I demanded a finger stick immediately. The physician also told me I was taking my thyroid medicine “wrong” – “You must take it at 5 AM on an empty stomach”. I take all my meds at the same time at night, which is more convenient for me. BTW, my blood panels are near perfect. I just smiled at her and nodded. The attending nurse (you could tell, she was a 15+ year veteran) told me that the IV was “ringers” and not dextrose. (ringers are just a cocktail of salts, no dextrose). I thanked her for her help. My finger stick was 120. The attending physician went away which was good, I already couldn’t stand her.
I was transported to my room, and in the 30 hours in the hospital I was “treated” by 3 attending nurses. When they came on duty I had short discussions with each of them. They were interested so I showed them my pump and gave them a lesson on how it worked. There were generally nice and seemed very interested. The rest of my stay was uneventful and boring and I went home Saturday night.
It’s important to be clear and to stand up for your rights. If a doctor comes on strong – then sometimes intimidation is required to get what you need. Never forget THEY work for YOU.
PS abdominal surgery is painful, but thankfully the pain meds don’t mess with bs numbers. It’ sSunday and I am feeling pretty good, too.
Cheers
Thanks Joe,I am sorry you went through that but glad to hear you have gotten better....I have always felt I was at the mercy of doctors,especially with my daughter and this type1 issue.I am thankful to get this information in case she does go on the pump,but even on shots it is important to watch closely in the hospital setting....ok,when a person is 18,what does that mean for me as a parent-do I still have rights to speak up for my daughter or does everything have to be from her ? When is a person considered to be an adult ? age 18 ?
Yeah, I would think Joe's story is typical. I've only been to the hospital once, and the doctors knew that people with diabetes wear pumps, but not really what it does, how it functions, the differences of basals and boluses, etc. I gave them a nice talk about it and I think they found it helpful.
When I had my wisdom teeth out, however, my oral surgeon's son had type 1, so he let me do pretty much whatever I wanted with my insulin and pump and stuff, and he knew everything. That was nice.
I want to just quickly respond. i was in the hospital 2 times since I was on the pump,my 2 children being born. The first one, i didnt know what I was doing and I didn't know what say I had in dr.'s care. The worst experience was recovery. They told me to go off the punp, and they would check my sugar and give me insulin as needed. They would check it and it was in the 200's after surgery and my husband would request insulin, and they told him I didn't need it. He got my tester and started doing it for me as he was watching me climb even higher. My doctor and husband accually argued and my doc told him he can't chase fingersticks. after hours of a stubborn dr. not listening, and a few nurses trying to sneek some shots in, my husband connected my pump and didn't care what the doc. said. With my second child, i switched doctors and told her, i am on the pump and plan on staying on, and taking care of myself throughout pregnancy and delivery, and she was fine with that!! I kept juice, testing supplies and my full pump, and I drank( I kept all my little apple juices stacked from all the hospital meals), suspended, bolused, and lowered rates as needed, and that worked fine!! I do believe you have to stand up and do what is right for you
My experience was similar to everyone else's...the nurses and doc's knew pretty much nothing about my pump. I had to take my pump off when I had surgery (c-section to have my little girl) and was on an insulin drip for a few hours before hooking back up to my pump. I was able to use my own meter, which was really good, so make sure your bring yours. Otherwise, you're at their mercy for when you test and they will get crazy about "lows." I was 90 and the nurse wanted to give me a whole cup of juice for my "low." And I was like, uh...yeah, I'm NOT drinking that because then I will be 300! What was really good for me was that my endo had privleges at the hospital I was in, so his name was on my chart and he came to visit me each day and look things over. I think that he basically told the nurses to let me do my own thing with my D, that I was in control and knew what I was doing. I'm pretty sure he wrote that in my chart as well. That went a LONG way in giving me credibility with the staff and they pretty much left me alone after that. They'd just check in and ask me if I needed anything or if I needed to call my endo with any questions. I whole-heartedly agree with what Joe said, REMEMBER THAT THEY WORK FOR YOU and that you can refuse anything that sounds wrong or off to you.
I have had to go to the hopital when I was 13. I was at my aunts and I was runing high so my aunt took me to he E.R and I loved the docter and nuces because The docter let me keep my pump on they just and what kind insulin i was on. and i think they asked the basel rate. i did have to have blood work done. but that was because they wanted to make sure everything was ok and stuff was ok. I think that they said my white blood cell was down a little but nothing elsa. Than they would come in about every 30 min and check to see what I was. and they did about one more check and they said i could go home. They only keeped me because they did not want to send me home if I was over 300 and they said they would like to see me down to at the 200's before they would let me go home.
I'm not on a pump, and the only time I've stayed overnight in the hospital was during my c-section. I found that if the nurses or residents disagreed with my "plans" for treatment, I'd have them call the endo on call and they'd listen to her (who of course agreed I needed insulin for food or whatever....). I also had a problem where medical assistants (not even nurses) were coming in to berate me about my "terribly high" sugars (i.e., 160). I just informed politely them that I was declining any D-related services or consultation unless it was with someone from endocrinology b/c I had my own supplies with me. As someone else said, I had my own meter and tested once an hour, so I could consult with the endo resident when she came around. But, in general, they get a lot of T1's in the high-risk OB practice there, so I had caregivers who were pretty open to my explanations.
Re your daughter, it's true that once she turns 18, you won't have a say in her care. But, at the same time, you can still be with her and act as an advocate. In various trips to the ER for non-D related things, both my husband and Mom have acted as advocates if I needed sugar, a BG test, whatever. It's not like they were choosing my care, just explaining how things work to the nurses, so it was fine.
No. I actually can't believe that most hospital staff know nothing about pumps. It is like they live in a bubble or something.
My doctor is affiliated with the hospital I go to when something happens and I always tell him if I am having surgery or something so the operating surgeon knows ahead of time that I can keep my pump on. I have had two surgeries with my pump with no problems. My orthopaedic is actually well educated about it which is surprising.
It is the hospital staff that knows nothing. My endo has to actually call in to let me use my own meter and strips too. One time they wanted to put me on NPH, Regular and humalog I was like umm call my endo ASAP. He had to tell them that I know what to do and NOT to put me on any other insulins its crazy!
One time a nurse was like Oh is that an insulin pump? Can you show me how that works...
Oy Vey!
[quote user="Joe"]
~LONG
generally speaking, no. most staff know little - to - nothing about a pump and insulin.
I had my appendix out last Friday morning - here's how it went: I go to the ER with abdominal pain and needed a CAT scan with contrast. no worries, no one even cared I was on the pump yet. Then the results come in and I need to get admitted to get my appendix out. My first discussion are with the admitting staff and my current medications. It’s important to say, Insulin – via PUMP. This goes into your record and believe it or not, most doctors will leave your current meds alone, including your delivery. By telling them you are on a pump early, it goes on the record and it becomes “gospel”. Very few people will have an opinion or tell you to take it off, once it is in your record.
I stupidly left my meter in the truck, so I was at the staff mercy regarding finger sticks. When I asked, however, they were nice enough to come over and stick me. Things were going well, but I was fasting for over 14 hours and I went from 80’s to about 61 – and this began my first round of “lessons”. I told the ER nurse to bring me carbs, like a 4 gram glucose tab, they didn’t have any. I was due to go into surgery, so I couldn’t have fruit or juice. The best solution was to go on a dextrose IV. Now I asked and the staff told me there was 5g dextrose per 100ml saline – so I kindly asked for 200 ml. I had to demand to be taken off the dextrose bag, those do-do heads would have left me on the bag and I would have had a bs of a zillion. The next test right before surgery was 130, and I thanked the nurse who switched my IV bag back to saline and said “see – Perfection”! If had not intervened I would have been left on dextrose.
The anesthesiologist and I had a nice talk. I said – If you are planning on taking me off the pump I will refuse treatment. She was very knowledgeable regarding insulin and agreed that I could keep the pump on and I would NOT get the dextrose bag, but she wanted a lower than normal basal rate. I lied and told her the lowest I could go was 50%.
In recovery I had my biggest issue, the dumb-a$ attending physician was a 2nd year resident, menaing she had very little experience. She wanted my pump off because “I wasn’t eating so I didn’t need it”. I gave her a short lesson in Type 1 and basal insulin requirements, since she was sooo much smarter than me she barely listened. Then she glanced at my IV and informed me I was on the dextrose drip. The bag was way behind me – so I couldn’t read it myself! I sat up on the stretcher and said I wanted everyone in the recovery area front and center for a severe beating. I demanded a finger stick immediately. The physician also told me I was taking my thyroid medicine “wrong” – “You must take it at 5 AM on an empty stomach”. I take all my meds at the same time at night, which is more convenient for me. BTW, my blood panels are near perfect. I just smiled at her and nodded. The attending nurse (you could tell, she was a 15+ year veteran) told me that the IV was “ringers” and not dextrose. (ringers are just a cocktail of salts, no dextrose). I thanked her for her help. My finger stick was 120. The attending physician went away which was good, I already couldn’t stand her.
I was transported to my room, and in the 30 hours in the hospital I was “treated” by 3 attending nurses. When they came on duty I had short discussions with each of them. They were interested so I showed them my pump and gave them a lesson on how it worked. There were generally nice and seemed very interested. The rest of my stay was uneventful and boring and I went home Saturday night.
It’s important to be clear and to stand up for your rights. If a doctor comes on strong – then sometimes intimidation is required to get what you need. Never forget THEY work for YOU.
PS abdominal surgery is painful, but thankfully the pain meds don’t mess with bs numbers. It’ sSunday and I am feeling pretty good, too.
Cheers
[/quote]
i just want to make a few corrections to your references in your story. there is no such thing as an attending physician who is still a resident. there is a resident and there is an attending under which they act and treat. she may have been a resident and typically you will see residents more often than the attending. there is no such thing as an attending nurse. there are charge nurses which are in control of a group of regular RN's or a hospital unit. they do rounds on pt's and it wouldn't be unusual to see them.
hospital staff generally don't see much of pumps or even diabetics that "take charge." what they see are the very sick people who are unable or unwilling to take care of themselves and if that's all you see day in and day out that's what you expect. If all you see is the worst then its hard to expect the good.
It's great to take charge in a hospital, especially if you are someone in control of your diabetes and are there for something generally unrelated (like having your appendix out). but 1 person out of 100 who actually knows and wants to take of themselves is rare, and unfortunately the majority that are the hospital give the rest of us a bad rap that we have to try to counter every time. Have some sympathy and realize that.
As a nurse and pump user I will have to admit that there is no education about pumps for nurses unless they happen to work in an area that see a lot of them such as with an endo. However, most nurses on my unit have asked me to show them how it works and walk them through it so they at least have a baseline idea of how it works when we have patients on them. The rare occassions we do have patients on pumps they generally control it themselves and just tell us what they are giving so that we can double check it. Again these times are few and far between so most nurses (and doctors I assume too) are not weel educated on the pump unless they learned it from someone.
-Rosemary
[quote user="Jessica"]
i just want to make a few corrections...
It's great to take charge in a hospital, especially if you are someone in control of your diabetes and are there for something generally unrelated (like having your appendix out). but 1 person out of 100 who actually knows and wants to take of themselves is rare, and unfortunately the majority that are the hospital give the rest of us a bad rap that we have to try to counter every time. Have some sympathy and realize that.
[/quote]
hey thanks for the corrections I am only a patient and don't know all my hospital lingo - I only know just what I heard, and I can say positively that I was under the influenct of controlled dangerous substances at least half of the time I was there.
The "doctor in charge" of recovery was a abrupt, misinformed, pushy, stubborn and myopic individual. She was in fact wrong, and attempted to influecne my recovery with poor information. There is no way to know everything about every condition, for this I have sympathy - however, for NOT LISTENING to your patients, for being overconfident, and for mis-reading the IV bag I have ZERO sympathy - in fact if I was feeling better I would have marched her in fromt of the hospital administrator for the beating she deserved. ...and if somehow this offends you Jessica, I am sorry you feel that way.
If you are in health care, then you must realize there is absolutely no tolerance for mistakes. If you go in like a bull, you will likely break things and you will always influence opinions in a bad way. If you don't listen, and close your mind, then you will likely fail or become a supervisor of some kind.
cheers
apparently your endo was not involved in your care at the hospital? I can't believe they withheld your insulin!!!