Diabetes Self-Management Blog

Monday morning, I went to see an orthopedic surgeon and, after having been duly warned about possible complications that could be heightened by my diabetes and asthma, took a deep breath and agreed to have one of my knees replaced.

To be honest, it isn’t something I want to do. However, my knees are so bad that it’s really impacting my quality of life. It’s painful to walk. It’s painful to stand in one place for long. I can’t “play” in the kitchen like I used to. Even more importantly, it’s really cutting into my shopping.

I don’t like pain. I don’t like being incapacitated. I don’t like taking a chance of picking up one of those infections that seem to float around hospitals. Hospitals are the absolutely worst place for somebody with diabetes to be. And, finally, I don’t like having to put up with health-care professionals who think they know more about diabetes—and, in particular, my diabetes—than I do.

The “in-service” with the orthopedist’s office has already begun.

It began with the nurse, who asked me how much insulin I took per day.

“Well, it depends …” I said.
“You mean you don’t take the same amount every day?”
“No. Does anybody any more?”

Of course, the fact that she asked said something about the quality of diabetes care in this community, if primary-care physicians are still putting people on a set amount of insulin rather than teaching them how to adjust based on all those factors that seem to change every day.

Then it was the doc’s turn: “While you’re in the hospital, we’ll put you on a sliding scale [of insulin],” he began.
(“The hell you will,” I thought.)
“I can take care of myself,” I said. “I have an insulin pump.”
“Huh,” he said. “Who implanted it?”
(Implanted?)
“Um, I attach it,” I told him. “It’s subcutaneous.”

He then did something smart: He asked for the name of my endocrinologist.

After your admission to the hospital, it’s then assumed by all that you know nothing about a condition you take care of every day.

Why is that, I wonder? Can’t they begin with the assumption you know what you’re doing and go from there, rather than starting out treating you like you’re an idiot?

From time to time, I harp on the importance of knowing about diabetes. This is especially important when you’re dealing with a stay in the hospital.

True story: An older woman went to the hospital emergency department with hypoglycemia. The nurse told her not to take any more insulin. Two days later, the woman was admitted in diabetic ketoacidosis with a blood glucose level of more than 1,000 mg/dl.

Another woman was told to take off her pump at midnight and not to take or bring any insulin to the hospital with her for an outpatient procedure.

Two night nurses wanted to take a patient’s pump away overnight because they “didn’t want to deal with it.”

There have been numerous stories of nurses who give an insulin injection for a meal that doesn’t arrive for an hour or more.

A nurse in a hospital I was in once took away a person’s regular gelatin dessert because “diabetics aren’t supposed to have sugar.” Never mind that the person’s medicines were balanced with the carbohydrate content of the meal and the person became hypoglycemic.

Anesthesiologists with plans to send your blood glucose soaring because of some cockamamie idea of how an insulin pump works will knock you out while you’re trying to correct their misinformation. (Ask me how I know.)

Personnel in another hospital carefully kept a person’s blood glucose above 200 mg/dl so she wouldn’t get hypoglycemic. (Didn’t do much for healing, but hey…)

Many places still don’t know that metformin (brand name Glucophage) is supposed to be discontinued before a procedure that involves injecting contrast dye into the blood system and not taken for at least 48 hours afterwards. They also may not know that metformin is one of the ingredients in Glucovance and in Metaglip.

So we all need to know how to take care of ourselves. Plus, we need to train a spouse, partner, or friend to act as our advocate in case we can’t take care of ourselves.

In the meantime, I’ve been wondering another thing about this knee replacement: Contacts help me see. I have more bridges in my mouth than Venice. I have a mechanical pancreas (a.k.a. an insulin pump). A continuous glucose monitor tells me what my blood glucose is at any given time.

Am I Borg, or am I merely turning into the $6 million woman?

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Comments
  1. Fix the knee if it MUST be fixed and then get out of there as quick as you can! Also one might consider hiding some insulin in a sock (like Kathy did) or bringing appropriate food, like I did. Good luck!

    Posted by Chrissie in Belgium |
  2. We appreciate your anecdote.

    If you would provide this information to hospital health care workers (I’m sure there are one or more groups) that WOULD be a REAL community service.

    Posted by spongebob |
  3. I, too, am looking at a future knee replacement, with diabetes and asthma. My meter, my Novolog pen, and my glucose tablets will be with me when I finally give in and say “do it”. I’m trying to get older and thinner first!

    Jan, my prayers are with you for a swift, complication-free recovery!

    Posted by Ephrenia |
  4. Call the hospital and find a certified diabetes educator to guard you. If they don’t have one insist that an endocrine doctor follow you before, during and after surgery. Glucose control is not optional, it’s a must. Don’t go to an orthopedic specialty hospital - they are great with bones but not much else - asthma, diabetes, hypertension, heart disease.

    Posted by Nurse CDE |
  5. Dear Jan,
    You are so very right about doctors and nurses taking care of diabetics. I am a diabetes educator (RN) in a small community hospital, and I have diabetes. I have been pumping for 6 years. My hospital had no diabetes department to speak of until they hired me 1 1/2 years ago.
    Since I have been here, my primary goals have been to get ADA recognition for diabetes classes, educate the physicians in the benefit of insulin pumps and train the nursing staff in diabetes. No one knows what they should about diabetes unless they have it.
    So far, I have gotten very good results with the nursing staff, but the docs are still lukewarm toward diabetes.
    My best advice to you is to be a tiger when it comes time to go into the hospital, letting them all know YOU will take care of your insulin requirements. In my experience, if a patient puts their foot down HARD, the staff usually will back off.
    Good luck. I’ll be waiting to read what happens.

    Posted by sfsrn63 |
  6. Hi Jan, I would advise against having a knee replacement until you have tried several exercises that physios give you. It saved me from having a knee operation.

    When I go into hospital, no-one is allowed to take care of my diabetes but ME

    Posted by sydneymum14 |

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