Diabetes Self-Management Blog

“They warned me about you,” my nurse said as he busied himself with blood pressure cuffs and other paraphernalia.

“Warned?” I mumbled around the thermometer in my mouth. “’bout what?”

“I’m told you ask a lot of questions,” he responded.

Darned right I do! When you have diabetes, you’d better be asking a lot of questions, especially when you are in the hospital. In fact, you’d better be asking a lot of questions when you are in the hospital, diabetes or not.

I had what I hope is the final surgery on my leg and foot resulting from a torn Achilles tendon. This time it was to remove some hardware from my heel and to clean up and put a graft over another part of the incision. While the first two surgeries were outpatient, this time I was admitted because there was some concern I might have an infection in my bone. (I didn’t.) More good news: When I saw the doctor last week, the graft was incorporating and my heel — which had not been doing well — was healing.

But I digress. When you have diabetes, it’s imperative that you know how to take care of yourself. After all, that’s what you’ll be doing for the rest of your life. Diabetes is an ongoing condition. That’s why it’s called a “chronic” disease. Nobody is going to be hovering over you, telling you what you need to be doing. There is no magic pill that will get rid of diabetes. It’s up to you to keep yourself safe.

That’s true even in a medical setting, such as a hospital. Maybe especially in a hospital. I remember an incident several years ago when somebody was about to run an IV antibiotic into me. “What’s that?” I asked. “What’s in the bag?”

“Penicillin.”

“I’m allergic to penicillin,” I told her.

Oops! I’ve never seen anybody unhook something so fast.

Ironically, the hospital seemed more fascinated by the fact that I used an insulin pump — which is all it had written on the outside of my chart. What should have been there? A bright orange sticker with my allergies written on it. I’ve since learned to check for that, too.

When I am in a local hospital, my family practice doctor is in charge. He has agreed to let me use my own medicines in the hospital. I take them in their original containers, the pharmacy checks to make sure they’re the proper meds, and the nurse dispenses them to me.

This time, however, I was out of town and the doctor did not know me. For some reason, he refused to let me take my own meds. (At least, in the beginning.) Aside from the fact that an aspirin cost $5, one 500-milligram metformin (brand name Glucophage and others) was charged at $12, and so on, many of the medicines I take were not on the hospital’s formulary. In other words, they were unavailable and substitutions were made. As I had the nurse tell me, pill by pill, what each drug was, I refused those that had been substituted. After a couple of days of that, I was allowed to take my own pills. (I’d been sneaking them, anyway.)

To add insult to injury, the doctor did not approve the full dose on two of my medicines. He didn’t believe in taking more than 1,000 milligrams of metformin (I take 1,500 milligrams) and, for some reason, only approved one-fourth of my usual dose of blood pressure medicine (which was not the one I take, anyway).

Food was another problem. The first day, I kept asking people for something to eat or drink. After all, I’d had surgery that morning and hadn’t had food or drink for something like 15 hours. Did anybody pay any attention to me whatsoever? Nah! I finally sent my husband out to get a salad and a grilled chicken breast. Frankly, it was a lot healthier than the noodles with spaghetti sauce, canned fruit, and whatever else was on the tray that my husband ate.

In the meantime, I had some fun when I asked yet another person for something to eat: She muttered something about waiting for dinner, and I told her that my blood glucose was at 42 mg/dl (it really was!). She panicked, saying “I didn’t know you were diabetic!” and dashed off.

The head dietitian came to see me and gave me a list of foods that were available all of the time so I could make up my own meals. The doctor agreed that I could have food brought in from outside. The kitchen made a chef’s salad especially for me — and it was yummy.

The bottom line? If you let people know that you know what you’re doing, and you actually eat healthful foods, you’re more likely to get to choose your own meals. I suspect I had some help on my side, too: My traveling bud, Sandy, was the CDE at that hospital for 15 years, and I suspect she whispered in some ears. The head dietitian has Type 1 diabetes, so she is aware of what is involved in caring for it. Several years ago, I had been instrumental in convincing one of the nurses there that an insulin pump would be helpful to her. She is now head nurse. It helps to have friends.

Tests? Oh, do be sure to question any tests you’re not sure of. One morning, a nice young man appeared in my doorway to inform me he was there to take me to dialysis.

“I don’t do dialysis,” I said.

He was insistent. So was I.

“No, really,” I said. “My kidneys are fine. I think you have the wrong room.”

Which he did.

Oh, yeah. Take your own stuff to treat hypoglycemia (low blood glucose). Don’t depend on anybody bringing you juice or something when you need it. I had plenty of stuff because I know me: While most people’s glucose goes sky-high after surgery, mine drops. I’m not sure anybody would have believed that I needed that much sugar as I got my revised basal rates and insulin-to-carbohydrate ratio worked out.

In fact, I’d had so much sugar that first night, the breakfast of French toast didn’t look good. My substitute breakfast of scrambled eggs and toast didn’t taste good. I called Sandy and asked her to bring me a veggie omelet.

It’s good to have friends who will help you take care of yourself.

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Comments
  1. HOW LONG DO THE GASTRIC DISTURBANCES LAST FROM TAKING METAFORMIN FOR TYPE II DIABETES?

    Posted by FAYE |
  2. I read your article with much interest as I am going to have surgery for the 1st time since being diagnosed with diabetes (2007). I am going to have a total knee replacement in October.

    I will have an interview with the hospital personnel prior to the surgery and was told to bring all the meds I take (quite a few). I am not on insulin (just an oral med), but understand that they usually put you on insulin which is easier for them to monitor. I will being my meter to check reading myself just in case they don’t check it often enough.

    Would that be the appropriate time to ask if I can take my own meds. I take about 17 pills a day and I can only imagine what that would cost.

    I look forward to whatever info and tips you can give me.

    Posted by Judy Broussard |
  3. Here’s another hospital hint.

    My son was hospitalized. I stayed with him. The staff was aware I was unable to get around without help - they wheeled me to his room alongside him in a hospital wheelchair. He was there for 2 nights… luckily I had brought food with me for myself. On out last day there I was informed that had I told them (yeah, ok) that I needed assistance, I could have received a complimentary tray at each meal when his was delivered.

    Posted by Ephrenia |
  4. I’m so glad you didn’t have a bone infection! I’ve been thinking about you a lot.
    Hospitals are no place for diabetics - or people with fibromyalgia, either. Add food allergies to that and you have a no-win situation. I had the same difficulties with meds, but they finally had to break down and let me have some of my own in my room because they kept giving me the wrong thing. Another hospital gave me the wrong blood pressure med, which I only found out when a horrible rash spread over my adbomen.
    The worst was when I had to go to inpatient rehab after the hospital neglected to treat my fibromyalgia properly. In the hospital I was able to get plain food in the right amounts to keep my BG in check. In the rehab center, most stuff was pre-prepared and the only concession to my diabetic status was artificial sweeteners which I can’t use because of my fibro! There was frequent discussion of my husband bringing in all my meals before they finally got it sort of right. That was a month-long adventure I could have done without!
    Husbands and friends are a great support system!

    Posted by Deb |
  5. Usually your body adjusts to metformin in a week or two. For some people, never! They go on to other medications. Starting on a smaller dose and working your way up helps, as does the extended release version.

    T2, 15 years on metformin.

    -Lloyd

    Posted by Lloyd |
  6. Thanks, Jan, I really enjoy your columns. Best regards for a very quick and complete recovery.

    Indeed, hospitals can be a dangerous place to be — for anyone that doesn’t question authority . . . but, particularly, for a diabetic. Years ago, prior to a surgical procedure, I looked up at the IV drip and said to the nurse, “I hope that’s saline and not glucose, because I’m a diabetic.” The doctor looked at the nurse and, in a very low voice said, “Nurse, would you please replace the bag with saline solution.”

    During another hospitalization, two different doctors had put duplicate blood testing orders into the computer. So, someone would take blood and then ten minutes later, someone else would appear to do do the same. For five days, I had to argue endlessly with various lab tech’s who did not believe that what I was saying was true. Ironically, I was in the hospital for a massive blood loss and needed several units of blood that week.
    One particular night, the nurse was sitting to the left of my bed administering blood, and a lab tech appeard at my right and began to pull out his blood testing equipment. He didn’t even notice the nurse. She angrily said, “What are you doing — you can’t take blood while I’m giving her blood!” He just mumbled something and left.

    On two differnt occasions, I have had dieticians place me on a 3,500 calorie meal plan for over a week (without meeting with me beforehand). Naturally, I ate only what was necessary to meet my meal requirements. On the day of my release, (both times), I would get a visit from the dietician who would say, “I don’t know how this happened, but we had you on a high calorie diet — you should not be eating that much food.” Then, I would get a lecture about what I should and shouldn’t eat, ad nauseum, all the while protesting that I had the situation in check .

    I could go on and on. In the 25 years since my diagnosis, there have been too many similar incidents to count. Sometimes, when such absurdities occur, it can be the result of an overworked medical staff as we are in an age where hospitals are not run by doctors — they are run by accountants. Sometimes, the errors occur because of incompetence. Whatever the cause, everyone needs to speak up and monitor her/his own treatment — or arrange for a friend or relative to physically be there and act as an advocate.

    Regards and good health to all,

    Sharon

    Posted by Sharon |
  7. glad to hear you are doing so much better.

    Posted by phillip vaughan |
  8. I’ve been taking metformin for almost 10 years and every so often I’ll get what I call a funky stomach or diarhhea from the metformin. If you’re newly diagnosed and are just starting it, it takes probably close to a month or so. At least it did for me.

    Posted by Therisa |
  9. I’ve been Type-1 for 46 years and have had several surgeries recently. I am lucky that my wonderful Endocronologist is affiliated with the hospital where I have had all but one surgery. I meet with her before the surgery and she makes sure that her associates are aware of my situation and she is in contact with the surgeon. (She is located at a smaller clinic in another city)

    I always insist on bringing my own glucometer because after surgery, I need to test more often than they would be doing. Last fall I had colon surgery.I was not able to wear my pump so I had an insulin drip. I tested the next morning and was 42. I was not able to eat or drink anything at that point. I called for the nurse and told her she needed to stop the drip and told her I would continue to test and would connect my pump as soon as I felt that my glucose level was fine. She said that she needed doctor’s orders to do that. Luckily, 2 Doctors from Endocronology came in and told her that I was correct. My Endocronologist had asked them to check on me.

    You are so right. As difficult as it is to get some of the medical staff to realize that we know what we are doing, we have to be insistant and take control of the diabetes part of medical care.

    Posted by Dottie |
  10. Note to FAYE RE: GASTRIC DISTURBANCES FROM METAFORMIN

    How long? My experience — Forever.

    Dr. changed my meds, finally.

    Posted by Kathy |
  11. I never did adjust to metformin and started insulin in April. In July, my HBA1C was 6.5.

    Posted by Priscilla |
  12. will someone tell me why as a diabetic we shouldn’t soak our feet.

    Posted by liz |
  13. I feel gritty and like sand all over me especially in the eyes, what cause this plus I sweat so much my clothes are always wet so have to change many times. why

    Posted by kathy |

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