Sunday, October 25, 2015

High carb hospital food for diabetic patients? Get with the times!!

I usually am not picky about hospital food.  I guess I am one of those rare people.  I eat, therefore I am.  Not so with a recent stay at a community hospital in Cornwall, Ontario. 

If I could have sprinted out the door after surgery, knowing this … I would.  Luckily, I escaped on Day 3 … I had served my time, but not without having some of the hospital admins visit me, and I’m wondering if it’s due to my going public about how the surgery went (you can read about what happened at this link).

What really got to me was that being a diabetic, on insulin, I need to know what the carbs are in the food I am ingesting.  Yes, many of us guesstimate, but in my case, after talking to the dietician that day afterwards, what I was being served was the diabetic meal plan.  If I had gone with my estimate of what chocolate pudding was worth … I would have ended up in hypo fairy land.  Luckily, due to having abit of an issue with high blood sugars, and spewing my guts (I had not been asked about my ketones at this point by the RN, just a disgusted look from her as I spewed … oops … hope you are not reading this at meal time … if you are … this is it for the head rolling Linda Blair of Exorcist fame spewing).

Okay, now to the serious stuff on …. high carb food content in diabetics meals served to patients in hospitals.  I had a good talk with the dietician, who led me to believe that she understood diabetic diets, but it still left me scratching my head with the following:

72 grams of carbs for breakfast

Yuppers, that is over half of what I eat in carbs for a whole day!!!  Luckily, this meal never arrived, something else did in its place of similar carb count – but again, nothing showing carb count on containers except for “diabetic meal”).  I had asked the dietician the day before, why the regular Boost was being given to a diabetic, when there is a diabetic version of Boost available (I kept on getting the 36 gram version for some reason .... and no ... I did not touch it with a 10' pole). .  

She managed to find a diabetic Boost to help me at least get something into me (my appetite has taken awhile to return since surgery ,... and losing weight has been a bonus for me because of this). She said they didn’t stock much of and believe it or not, the 16 grams of carbs and 16 grams of protein according to the label ...  I spiked so high (yes … think of someone with a lot of gel in their hair), and stayed high, even with proper insulin coverage.  

I think where the food plan for diabetics in this hospital rests due to them following the ADA/CDA food plan which tends to be high carbs and aimed at the population of Type 2.  Sadly, even the CDE’s had questioned me when viewing my Diasend results a few months earlier  that I do not eat enough carbs and therefore my body can’t function properly.  It’s like, excuse moi, I’ve been eating this way for years … do I look unhealthy ... I rarely get sick except for as blue moon year?  Hullo!!!  I function well and know of many others that are the same  (no – not the Dr. Bernstein regime of 30 grams / day … I’m more like 120 grams / day … sometime more when I have a sinful slice of chocolate layer cake).

So perhaps dieticians, CDE’s of hospitals if they would take into consideration that not EVERY diabetic has the same eating habits as the rest – and perhaps be allowed to choose their meal plan while staying in hospital – then great.  In the 3 days I was in hospital, there was no protein (do budget constraints mean that a simple hard-boiled egg, slice of cheese, peanut butter aren’t possible for the patient?).  What was funny, my DH was bringing me my morning coffee from the in-hospital Tim Horton’s that actually sold hard boiled eggs.  He said it didn’t dawn on him to buy me a few …. Duhhhh … you can see who cooks in our house. 

So, next time, if there is ever another time at this hospital (or any hospital – I have a feeling they are all the same due to budgets, etc.)  I’m bringing my own cooler full of cheese, hard boiled eggs, sliced meats, etc.  And perhaps if you are reading this, and going in for surgery, hopefully you have a diabetic team at your hospital that will ensure you get the proper food plan, or at least listens to you.  Somehow, in my case, I think I slipped through the cracks …. it’s okay, I’m alive and writing about my experience so others can learn from my mistake!

NB:  Incase you’re wondering, if I had stayed longer … my lunch was ringing in at only 70 grams and dinner was 62 grams … and none of those meals contained any protein.  
At least he got some protein to slow down the carbs!!!

Sunday, October 4, 2015

Falling through the cracks of a small town hospital

Falling through the cracks of the Cornwall Community Hospital (CCH) system … that’s the only way I can come up with an explanation of what happened with my insulin coverage last week during a 4-5 hour period when I was asked to stop my insulin pump from delivery insulin during surgery.  I put Ziggy into 0% basal rate for 4 hours – but now think I should have lied and just left him on. 
The Womb With A View
I think due to the diagnosis 2 weeks after my initial visit to ER for heavy bleeding and I was in menopause stage of life, along with the fast turnaround of 2 weeks after that for a spot on the slice and dice table this may have resulted in mistakes being made in what occurred that day with Pre-Op / miscommunication with the CDE’s / gas woman aka anesthesiologist, etc.  

Was pre-op done to close to the surgery date?

In past surgeries (e.g. mastectomy done in 2007 for diabetic mastopathy ), the Pre-Op, meeting up with endo team, was all done within 2 or more weeks of the surgery date.  In my case at CCH, pre-op was done 2 days before the surgery day  ( DH came along ).  The RN didn’t say anything about whether pump would be allowed or not, but took down that I wore an insulin pump,along with my total basal rate, average basal rate (this same information was given to the Pharmacist from the CCH the next day who said it was unusual for them to be left out of the loop for pre-op).   The RN was fully aware that I was being seen by the Diabetic Clinic within CCH and I “assumed” they would be contacted for any help (they were already aware of my upcoming surgery by an email I’d sent to them).    

Was any blood sugar testing taken during the surgery and didn’t
my CGMS alarms make them aware?

Sadly, I didn’t think of the CDE statement from an email earlier during the week when I’d asked her about wearing the insulin pump during the surgery …  

“do you have a protocol for not wearing pump during surgery”

Her response to my query, with no suggestions,  made it obviously clear to me I was on my own with handling my diabetes control in the hospital (I have since learned she expected me to respond back with my answer). 
I assumed that when the anesthesiologist (gas woman) firmly told me that she would not continue if I kept the pump on, that insulin would be at least provided in the drip.  This was told to me as I was already being strapped down to go to la la land of no pain and she meant business (she wasn’t happy with where the RN had set up the drip, but my veins are sparse and RN didn’t go to my hand which has LOTS of plump veins and has been used in the past by the blood takers).  So, basically, I had no time to say, “ let me get my overnight bag and shoot up with Lantus “.   Yes, I was in a tough position at that point, trying not to panic.  I had come prepared, but not at the last minute when the surgeon’s clock is ticking for his other scheduled patients that were behind me!!  Gulp!!

My hospital gown had the washy washy instructions to ensure no evil germs develop!

Granted this was my first major operation using an insulin pump.  Previously, I was on MDI, and with pre-op it was always determined that I do my regular long acting insulin shot and that after surgery that I took over my diabetes control.  Did my being on an insulin pump throw off the pre-op and pharmacist?  This is where both my husband and I wonder …

was any insulin drip given during the 4-5 hours I was under their care?

My darling husband (DH) had been contacted at noon time as I was being wheeled into my room after being in recovery (surgery had started between 0730 – 0800 ) and he arrived about an hour later to hear my story about the blood sugar reading of 22 mmol/l (396 mg/dl) and how the staff had determined I should be given 10 units of rapid insulin.  I vaguely remember all this happening, and again, have no time reference.  I hope I didn’t yell, but I told them it was too much.  I remember being asked what they should give me and in my state of mind was calculating 1 unit of insulin would be lower me down 3.5 mmol/l (63 mg/dl) and told them to give me 3.5 units (if I’d been more with it I should have said 5 units).  I don’t even recall them giving me the injection. 

I was having to rely on someone else to take care of my diabetic care at this point that
had wanted to inject me with 10 units of insulin

My DH at that point looked at Bowie my CGMS and it was alarming like crazy (we are wondering now if the trainee RN who was holding him during surgery noticed this).    Bowie does not like being high, and was still registering at 22 mmol/l (395 mg/dl).  At this point, having my DH by my side, I was more with it and did my own finger stick test which showed I was around 14 mmol/l (252 mg/dl).  Obviously the insulin was working (maybe they did an intramuscular injection (IM) into my arm to make the insulin work faster … which is what I do when my BG is that high – but due to no time frame of injection I’m unable to figure it out). 

With insulin coverage for a T1D it’s all about what TIME insulin is giving … 
method of injection ... site it`s injected into …

This is where even more confusion starts is that the RN that was speaking with my husband didn’t realise that my pump was functioning.  Again, either I did not explain myself properly to the gas woman / RN when turning my basal rate off for the 4 hour surgery time.

So, even now as I compose this blog, trying to put together what occurred, it seems like a dream

So, DiabetesMine ( @samanthachan at Instagram)  … I told you the true story would come  with the picture that you asked permission to use at the Diabetes Innovations Summit at Stanford in November.  Even though the trainee RN who held Bowie during surgery had been warned about what would occur if my BG’s went up or down with him alarming.  I think he was ignored OR even worse case scenario when he was finally looked at, they assumed that that was the correct blood sugar number.  That is even after I  had told her and various staff earlier and during my 2 day stay that the CGMS reading HAS TO BE verified by a blood meter.  The fingertip NEVER LIES when it comes to real time blood sugar number. 

Victorious thinking I`d be allowed to use pump during OR ... NOT

It’ll always be a mystery to me … and personally I will not return to CCH for any surgical performance if I cannot go another route (see note below).  This is after speaking to other residents where I live, they avoid it at all costs.  Though if it’s a situation where I’m not able to drive to the next closest hospital ( Winchester District Memorial Hospital has been recommended to me by many people in Cornwall ), I just hope/pray that I have someone on my side (my DH or another T1D) able to ensure that my diabetes health care does not get lost in the cracks like it did with this hospital experience.

NOTE:  The one thing I have learned out of this experience is that hospitals in Ontario have different ratings (and probably in other provinces of Canada).  A few members from the CCH Diabetic Clinic came to speak to me due to what had occurred the day before with surgery.  They had stated that CCH is a #1 hospital (I have tried to find anything pertaining to what they had told me online but have come up empty handed so this is “my version” of the “rating system”).  If my surgery had been performed at either Kingston or Ottawa, which are larger populated areas, then  insulin pumps would be more accepted and understood by the medical staff members, and perhaps allowed to remain on in the OR. 

Day after the surgery - attempting to drink a Timmy`s