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This blog got its start quite byaccident and not one putting anyone or me in the hospital this time. In discussing patient centered care with David Mendosa, I ratherexploded about hospital care. David, in his calm and collected wayasked if I had read any of Dr. Bernstein and I had to admit I havenot. David said he would provide me with a link to his blog about aletter to get signed when entering the hospital. After reading this,I may have to get up the courage to read Dr. Bernstein’s book. Unless there is something that I am researching, I seldom take timeto read a book for the pleasure of reading. Since I do a lot ofresearch about type 2 diabetes, I am not reading much published onthe type 1 side of the spectrum. No one to blame but myself.
Back to hospitals and why they are onmy list of “avoid if at all possible”. It is understandable thathospitals and doctors have an aversion to lawsuits and this drivesmany of the healthcare decisions they make. People with diabetes isone group that pays dearly for this aversion. Hypoglycemia is thefear that draws attention and dictates much of the policy for carewhen person with diabetes is hospitalized. The term that is used formost healthcare is defensive medicine. For patients with diabetes,this means allowing blood glucose levels to be maintained at levelsthat slow healing and can lead to increasing the risk forcomplications to develop. Thus the hospitals are caught in conundrumfor care. The chance of hypoglycemia depends on the medication andif the patient is on insulin or sulfonylureas the hospitals use alevel of blood glucose that will generally avoid hypoglycemia and isin the hyperglycemia range. Most, but not all, hospitals want thelower limit of blood glucose to be 180 mg/dl (10.0 mmol/l) orslightly higher. The longer your blood glucose levels remain at thislevel, the more you are at risk for complications. Because of thesmaller likelihood of you developing complications while underhospital care, this is the goal of most hospitals.
Another area that patients withdiabetes need to be concerned about is diet while in the hospital. Forget that you have diabetes and please do yourself a favor and donot request the diabetic menu. Because the dietitians for thehospital follow the American Diabetes Association in diet planning,the menu is high in carbohydrates and low in fat. This creates allsorts of problems for patients with diabetes. Those on oralmedications will have extra problems because of lack of movement orany type of exercise. Those on insulin (which most that arehospitalized are converted to at least while hospitalized) will runblood glucose levels of 180 mg/dl or higher. The one procedure Iwill commend hospitals for is giving rapid or short acting insulinafter meals so that if the patient does not or is not able to eat ameal, hypoglycemia is averted by not giving an insulin shot.
If you are scheduled for an operationor admitted to the hospital in an emergency situation, please beaware of the above problems and consider the letter in DavidMendosa's blog. Even if it is an emergency admittance, if a familymember or a close friend can advocate for you and have the letterpresented, this may help. A reminder, you may have to stand yourground as most hospitals will refuse to allow you, the patient, totreat yourself for diabetes because they do not want the liability ofsomething going wrong. I dislike saying this, but you are are higherrisk of surgery complications and even death if the hospital keepsyou on their diabetes regimen. Studies have shown this to be trueand as a patient you need to be aware that this can happen.
I have a friend that lost about $300because a nurse confiscated his insulin and testing supplies anddestroyed them. Horror stories like this abound and this is becausethe hospital medical staff lack the training in diabetes care andsome just don't care. Others do care and if you are mentally capableof managing your diabetes, they will allow this to happen evenagainst hospital policy. So do consider the letter in David's blogand if needed adapt it to fit your needs. You will benefit yourhealth by managing your diabetes versus letting the hospital manageit.
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