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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Don’t Let Hospitals Ruin Your Control

May 28th, 2010 · 4 Comments

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When I had elective surgery a year and one-half ago and then when I had an emergency operation about six months ago, I told the hospital that I wanted them to provide me with a diabetes diet. Big mistake. They have no idea what a proper diabetes diet is.

At that time I had read the book by Richard K. Bernstein, M.D., Dr. Bernstein’s Diabetes Solution. But I hadn’t focused on his guide to hospitalization. You can be sure that if I have a chance, the next time a hospital tries to run my diabetes life, I will guide it with a letter to them like the one here.

This week he told me that I was free to reproduce that guide here. What happened was this.

One of the regular readers of my articles here sent me a copy of a letter that she had written protesting the awful treatment that she had received in a hospital in Wyoming and in another hospital in Colorado. She wanted to get the letter to Dr. Bernstein, who she and I both look to for guidance on controlling our diabetes.

When I passed on her letter to him, Dr. Bernstein was sympathetic. But he added that he gets even worse horror stories from other people who run into our American health care system.

“They all relate to the ignorance and lack of compassion of physicians and hospital personnel,” he said. “I asked my literary agent if we should transcribe them for a book. I was told that people don’t want to read depressing stories, and no publisher would be interested. If you think this kind of thing would serve a purpose on your blog, just post a request for stories about interactions with medical personnel and you’ll be overwhelmed.”

Then, in a follow-up message Dr. Bernstein added that, “I warn people about this in appendix B of my book. If you want to publish that appendix in your blog, you may.”

So here goes:

APPENDIX B Don’t Permit Hospitalization or Lengthy Outpatient Procedures to Impair Your Blood Sugar Control

If ever it is necessary for you to become a hospital patient almost anywhere in the world, the chances are overwhelming that no reasonable thought will be given to controlling your blood sugar. Most of the medical orthodoxy doesn’t do it anywhere else, so why should they do it in the hospital?

The reasons for such neglect, of course, are many: lack of blood sugar control skills on the part of most hospital medical staff; unawareness of the importance of normal or near-normal blood sugars in the face of illness or surgery; and an almost pathological fear of severe hypoglycemia (and the potential for lawsuits in the United States if it occurs). Many if not most hospital dietitians have been indoctrinated by the ADA, with the result that diabetic inpatients are forced to eat high-carbohydrate foods and are deprived of protein and fat. Some of my patients tell stories of having to sneak in their own insulin and blood sugar meter, throw out hospital food, and fight tooth and nail with well-meaning but uninformed hospital personnel.

Many studies of hospitalized patients have demonstrated that elevated blood sugar delays surgical healing, increases risk of postsurgical morbidity and mortality, delays recovery from infections, and leaves patients open to new infection. It also has been shown to increase death rate of patients who have been hospitalized for heart attack or stroke, and increases the likelihood of a new stroke or heart attack.

What can you do to help keep your blood sugars under control while in the hospital?

Most of my patients live great distances from my office, so that I am not the admitting physician or surgeon when they are hospitalized, and I am thus not in a position to write their orders, help control their diets, and directly oversee their medical care.

After sharing the frustration of my patients over the years, I’ve come up with a letter that has worked repeatedly for elective hospitalization, such as for surgeries planned in advance. As you will see, it relies on the prevailing fear of litigation that appropriately permeates the medical care system in the United States. This letter should be sent by you or your diabetologist to the admitting physician, with a copy to the hospital administrator. I’ve composed the letter as if you were writing it, since the odds are that you are not under the care of a diabetologist. It can, of course, be modified to suit your circumstances.

Dear Dr. __________:

I am scheduled for admission to your hospital on __________. I have type [1 or 2] diabetes and am naturally concerned about control of my blood sugars while hospitalized.

It is now generally accepted that elevated blood sugar levels impede recovery, prolong hospitalization, and increase the incidence of hospital and surgical morbidity and death. Major health problems brought about by inappropriate blood sugar elevations during hospitalization have justifiably led to litigation.

Since I have been successful at keeping my blood sugars essentially normal around the clock, I naturally expect equivalent care while I’m in the hands of medical professionals.

I currently take the following medications for controlling my blood sugars:

[List here doses, times, and purposes of medication: “basal insulin (or ISA) to cover the fasting state – must be given even if not eating.” “prelunch (breakfast, supper) insulin (or ISA) to be skipped if meal is skipped.” Detail also any use of insulin, glucose tablets, or liquid oral glucose for correcting off-target blood sugars, etc., You may also include a sample GLUCOGRAF sheet and request that all medications used by the hospital that may affect blood sugar be listed on it if you are not capable of listing them yourself.]

My hospital orders should call for a “normal diet” and not a “diabetic diet,” so that I can select my own meals.

Routine intravenous fluids should not contain caloric substances such as glucose, fructose, lactose, lactated Ringer’s solution, or saline with added glucose (except for treatment of blood sugars that are below my target). All of these substances will raise my blood sugar to unacceptable levels. Normal saline solution is perfectly adequate for routine hydration. My target blood sugar is ___ mg/dl.

If I am conscious and without cognitive impairment, I should have full responsibility for treatment of my diabetes — without outside interference.

My blood sugar meter and blood sugar control medications, including insulin syringes, should not be confiscated by hospital personnel. This is a barbaric practice that is rapidly being abandoned in modern hospitals.*

If I am unable to care for my own blood sugars, I expect that the hospital staff will exercise every effort to maintain my blood sugars within the range of [00-00].

Sincerely, cc: [Hospital administrator]

[Close relative or friend]

This letter may also be of value if you are to have certain outpatient procedures, such as endoscopy, cataract surgery, hernia repair, and so on. These are frequently performed in physicians’ offices or in hospitals without the requirement for staying overnight.

*Many hospital pharmacies do not stock the products that we commonly utilize in this book, such as 25-30–unit insulin syringes with 1/2–unit markings, detemir (Levemir) or glargine (Lantus) insulins, and lispro (Humalog) or aspart (Novolog) insulins.

This is a mirror of one of my articles that was originally published on Health Central.

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Posted in: Psychosocial

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4 responses so far ↓

  • 1 Donna // Jul 18, 2010 at 8:36 pm

    I want a share a good experience I had with the health care community. About a year ago, I was
    feeling wretched and decided that I should seek medical attention. I had sat all afternoon in the blazing sun watching a football game, and afterward I felt terrible. I finally went to urgent care. I remembered what Dr. B. said in his book, and when I’m awake, I always get a bit belligerent in a health care setting around the subject of my diabetes (I’m a type 2, metformin twice a day, low carb diet, A1c 5.7-ish).

    They determined that I was dehydrated (and eventually determined I had a kidney stone)–so I very clearly said I had to have “normal saline”–”no sugar of any sort.” The doctor seemed to listen, and the nurse came in with the IV and the saline. I said I wanted to see it to be sure it didn’t have any glucose–sure enough, they had actually listened to me, it was normal saline, no sugar!–things went well, I felt better, and when the doctor came to dismiss me, he said “are you sure you are diabetic? you don’t have very high blood sugar!!” I just laughed!!

    Donna, at Bend Medical Center Urgent Care, Bend, Oregon

  • 2 Greg // May 16, 2011 at 7:55 pm

    My experience has taught me again and again how important it is to manage your own care even (especially) in hospitals.

    I have been a type 1 diabetic since 1998 (diagnosed at age 38). I have always controlled my blood sugar well by counting carbs and using multiple daily injections of humalog (using lantus once a day as basal) .

    I had experience several years ago in a very good hospital that scared the heck out of me. I was in the hospital for something unrelated to diabetes. Of course I had my meter and insulin. The nurse came in and started preparing a shot. When I asked her what she was doing, she told me she was giving me my humalog injection. I said I was good, telling her what my last reading was, and also that I’d would be managing my own insulin, just like I always did.

    She would have none of it. She was insistent that they would give me insulin, telling me how much insulin it would be and when. I have no idea where they got the dose or schedule (some “standard” formula?), but it would have put me in a coma. It was 4 times more than I regularly shoot after a typical meal.

    The scary thing is that it took a very heated discussion with her to convince her not to shoot me up. Thank God I wasn’t unconscious (else I definitely would have been….)

    That letter is a great idea. Thanks!

  • 3 David Mendosa // May 17, 2011 at 8:15 am

    Thank you for sharing your experience. It sure shows how important it is for us to stand our ground.

  • 4 Lisa Bolton // Nov 12, 2011 at 5:15 pm

    Thankyou for your website, it contains a lot of good information. I would like to share my hospital experience and emphasise how important it is to be in control of your own blood sugar. I was hospitalised 3 weeks ago with concerns about my pregnancy. I have gestational diabetes as well, which was perfectly controlled by diet when I was at home. (I was not hospitalised for GD, but rather for other complications). Since being in hospital and being given an almost pure carb breakfast, lunch and dinner, my BG levels have skyrocketed. I have had to be put on insulin for the first time and they keep having to increase the insulin levels. As I said before, I had never gone above a 10 at home, but am having quite high highs and very low lows which make me faint and nauseous. I have had to speak to the hospital dietician twice about how to manage diabetes through diet, but it seems that hospital is very conservative. They would rather increase insulin than give me a scrambled egg for breakfast! I am a nutritionist by profession, as well as a naturopath, so you can imagine my frustration! I am glad that there are doctors out there who are willing to help their patients by writing letters such as the one above. Maybe with some effort, we can change hospital treatment for people with diabetes.

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