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Quality Health Care and You - Diabetes

Hospitals, Surgery and Diabetes Management

11/10/2008

Question:

How does one negotiate with a hospital staff who think that insulin pumps are inherently evil (or they`re just stuck in the early 20th century) and want to switch you back to mdi because that`s what all their other patients are on? If one has surgery, and is knocked out on painkillers 90% of the time anyway is it the better option to go back on MDI or stay on the pump? My local hospital is not very diabetes-savvy and I don`t know what is in my rights as a patient in terms of diabetes care. Every time I am in there (for another medical issue) my diabetes control goes to pot and no one really cares. Any tips for surviving with the best possible care would be appreciated.

Answer:

Unfortunately, your situation is not uncommon, even in "academic medical centers" where diabetes knowledge has significantly lagged behind for the vast majority of hospital personnel caring for patients in hospitals. We are working slowly to correct this issue but it will take years to reach all necessary caregivers. Probably your best advocate is your local endocrinologist who can administratively work to inform and design education fro caregivers, and then to assist you in the practical management on the floors (on call coverage, etc,).

Unfortunately, hypoglycemia (low blood sugar) is becoming a major concern, and fear of pumps will only make fear even more real. We also share your frustration with blood glucose control deteriorating while in the hospital, not only due to situational stress, but sadly contributed to by less than competent caregivers on the floors. For major procedures the best situation is one in which an endocrine service provides 24/7 coverage and care of the diabetes, in addition to other necessary physicians/NPs. For now, this is our best hope.

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Response by:

Laurie   Sadler, MD Laurie Sadler, MD
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University