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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