Monday, November 21, 2011

Hospital/nursing home hell

For those of you that don't already know the story (everyone else, bear with me! :-)  )

At the end of August, 2010, after a couple of months of climbing BGs, which I was unable to control, I saw my endo. My fasting BG was 302, A1c 10.7 (really high for me), liver enzymes in the 100′s (normal is less than 40) and I was suffering increasing mental confusion, and blackouts, which I was unaware of. He did nothing; just sent me home.

6 days later, I didn’t show up at a picnic I was supposed to attend, and my friends came looking for me, and found me near comatose. The last thing I remember is them calling my name from outside the door. Good thing I leave my door unlocked, because they came in, found me, and somehow got me into the car and to the emergency room. The ER DID save my life, after testing me for drunkenness, drugs and dementia — the wrong 3 D’s. All my systems were out of whack, and I was in acute kidney failure.

So I was admitted, and remember nothing for a day and a half. According to the CDE on the case, they took a look at me — age 62, and decided I was a Type 2, and started me on Type 2 protocols. Which meant insulin on a sliding scale, only to correct highs, but no basal and no meal coverage. And then, couldn’t figure out why my BGs were going up instead of down. The reason for the Type 2 protocols is that they expect the patient’s own body to bring down postprandial highs, which is often (but not always) the case in Type 2′s. So the CDE fought with them to get them to use Type 1 protocols on me. Whereupon, my BGs started to come down.

Then, because I was no longer acute, they sent me to a rehabilitation hospital AKA Alzheimer’s home, which assured them that they knew how to take care of diabetics. Ha! I arrived there on a Friday night, and the hospitalist was off until Monday, and somehow the Type 1 orders didn’t accompany me. So back to the no insulin except for corrections, and going up into the 400′s after meals (and I was eating only protein, because I knew that carbs would just blow me sky higher than I already was), and they just left me sitting there with miserable highs for hours, because it wasn’t time for insulin yet. And I couldn’t corner the hospitalist until Monday, so I relapsed back to the place where I started, with confusion, hallucinations and blackouts. Worried about going low? HARDLY!!!

Finally, I got to the hospitalist, and convinced him I needed a basal, and boluses before meals, and he put me on fixed doses — wouldn’t let me take control for myself — I’m sure he was used to dealing with passive, demented patients. So I ate as little as possible, and slowly, slowly, my BGs started to come down. But I was there for THREE frickin’ weeks (plus the week in the acute care hospital), when, if I had had proper treatment to begin with, it should have taken no more than a week to recover sufficiently to go home. Fun with spending unnecessary money, and Alzheimer’s patients are SO much fun to spend all your time with.

As soon as I got home, I found myself a new endo (Type 1 himself), who immediately figured out that my insulin needs had changed radically, and put me back on my pump. I have since gotten things back to normal. But I am terrified to ever go in the hospital again, even though I really needed it at that time.

Side note: the sliding scale worked for me, once I was getting basal and bolus insulin, because the standard rule was 1u of insulin to lower BG by 50 mg/dl. A friend of mine, who has Type 2, was in a nursing home, and they used the same scale with her. But the difference is that she is very insulin-resistant, and needed more like 10u to lower her BG by 50 mg/dl. I can't understand why hospitals don't understand that diabetes, of either type, is not a one-size-fits-all disease!

1 comment:

  1. I am terrified to ever go to a hospital again. Those places are scary!