Tuesday, April 1, 2008

My hospitalization: Surrounded by ineptitude

When I was diagnosed as diabetic, I was sent to the emergency room. I spent the next four nights in the hospital, largely due to the fact that the doctors didn't seem to know what they were doing.

You might thing I'm exaggerating, but I'm not. I went into the hospital with a blood sugar of 515. They got it down to about 80 that first night, but then for the next few days couldn't get it under 250.

I mentioned that I recently found my old medical records. This is what the hospital's discharge summary says:

The patient's course in the hospital was relatively benign, although we had a hard time getting her blood sugars consistently under control for the first few days.

The main cause of this seemed to be a lack of communication. About a half an hour before a meal, someone was always sent to check my blood glucose. Then someone else would bring insulin and give me a shot. And after that, a third person would bring me a meal and put it in front of me. (Sometimes the meal actually came before the shot.) It didn't seem to occur to anyone that if they gave me insulin to correct a high glucose reading, it wouldn't do them any good if they then fed me right away — unless of course they also gave me insulin to counteract the meal.

The report confirms what I've always suspected: They were also way too conservative about how much insulin they gave me.

Lantus was started at 10 units in the morning with a sliding scale of Regular Insulin and through the course of her stay with us, she was switched to Lantus 18 units and Humalog q.a.c. and q.h.s. at 7 units.

(I looked the abbreviations up; q.a.c. stands for the Latin for "before every meal", and q.h.s. means every night.)

Even more interesting, though, is the "Discharge Medications" and "Discharge Instructions" sections:

The patient was discharged with Lantus insulin and Humalog insulin; Lantus 18 units q.p.m. and Humalog 7 units q.a.c. and q.p.m. along with the Lantus, although in separate syringes... The patient is to continue with her diabetic diet.

(I think q.p.m. means, or should have been, q.h.s.)

According to the discharge summary, they put me on a traditional 3-injections-per-day insulin regimen and a restrictive diet, which is so NOT what happened. I was discharged with instructions for carb-counting, which is where you determine your shot according to how many grams of carbohydrates you are eating. My ratio was one unit for every 15 grams of carbs.

So even my discharge report shows the lack of communication that plagued my entire hospital visit.


Irreverent Freelancer said...

So you immediately had to be put on insulin and never were a candidate for such drugs as Glucophage, Glucotrol, Starlix, Actos, etc.?

Katharine Swan said...

Right. Those drugs are for type 2 diabetics. Type 2 is insulin resistance, which those drugs enable the body to overcome (how it works I don't know).

Evidently the way they do it at the hospital when your sugars are that high is to start with insulin in order to treat it immediately. If it doesn't work, then they assume you're type 2 and start you on the pills.

Of course, I wasn't responding *well enough* to the measely amount of insulin they were giving me at first, so they started talking about me being type 2 and needing to put me on the corresponding drugs. Luckily my endocrinologist stepped in in time to prevent that.

Katharine Swan said...

Correction: He wasn't my endocrinologist at the time, but I ended up going with him after being released from the hospital. I switched to the Barbara Davis Center a couple years later.