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!!!

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

When life is just a bowl of hormonal chocolate cherries!

I haven’t had much time lately to blog.  Life has been crazy with the move in June,   recent death of my little Mia the black cat (aka my hypo awareness cat ... sigh).   Dealing with diabetes has been the easy thing, especially with the assistance of Bowie aka my Dexcom CGMS.  He’s actually singing away right now as I compose this … telling me I’m low … urrrhh … silly hormones that are going wacky lately (menopause, thyroid, lack of sleep, etc.) making life abit of a roller coaster ride.

What’s going on right now with me is from a recent trip to the ER in the new town I live in the province of Ontario (alot of folks from Quebec come here since the wait time in less – found that interesting).

It all started off with a visit to the CDE’s (Certified Diabetes Educator) team end of August.  They have knowledge of insulin pumping since Ontario has the insulin pump program (I think I qualify – but I just bought a new pump – on my credit card to get 5 years warranty instead of the 4 years Animas offers - having supplies covered would be nice until I need a new pump).  I do have a feeling though that I maybe the first CGMS user they've come across, after meeting up with another T1D pumper the other day, he was wearing a Medtronic pump and didn't know what it was along with Sure-T infusion sets (stainless steel ones) - or what an A1C test meant.   Out came my calling card, and hopefully I can get him to discover the #DOC .

I’ve been in menopause for over a year, hot flashes, emotions up/down/all around (combine that with thyroid that has once again wacky wacky … but no doctor to review TSH levels means I’m on my own until I find a doctor who I can convince I need help).  Well, maybe due to stress of move, etc.  I started to no longer experience those lovely symptoms, and instead, started to bleed heavy like I had during peri-menopause period.  That had lead my gyno in Quebec to decide the fibroids were too big and surgery was to be done (I opted out as you can see by this blog post).

The CDE’s were worried about my blood loss and exhaustion I was experiencing, so told me to go to the walk in clinic next door to the hospital.  I did, but after a 2 hour wait, seeing the head surgeon from the hospital that was doing his stint in the walk in clinic … he told me to go to ER … STAT.  He didn’t like the way things were in the nether regions and my history.

ER … ultrasound … gyno … biopsies … and just 2 weeks ago I got the results that things weren’t right.  We are not sure if the ovaries can be saved.  I am hoping so, but gyno is not sure until he can get to them.  I know at present I have what I call an “Igor” in my left side along with some little stragglers, I feel pregnant and ready to pop.  Dull pain is something I can handle, but it’s getting tiring along with now going back to menopause symptoms again.  Ovey … I feel like a woman!!!

So, really, diabetes is the least of my problems right now.  Being on the insulin pump, along with the CGMS aka Bowie (Continuous Glucose Monitoring System) I am managing to sort of keep things okay in that area of my health.  The rest is crap, but I know it’ll get better.

Pre-op is this Tuesday with surgery scheduled a few days later (yeah – no 6-12 month wait like Quebec).  I am hoping that I’ll be allowed to wear both my pump and CGMS during the operation (LAVH or Laparoscopically Assisted Vaginal Hysterectomy will be performed – less recovery time – yippee!!).  So cross your fingers for me.  I’m hoping that due to the high amount of pump users here in Ontario, that more hospital staff will be familiar with how they work, unlike where I was in Quebec. 

Life in The Bahamas as a T1D Pharmacist and CCDE

A few weeks ago I dropped in at Freeport, in The Bahamas when going on a short cruise for abit of R&R (escape from Old Man Winter ... like many Canadians do at this time of the year).  It was to finally meet up with Christine Snisky who is a pharmacist and CCDE (Caribbean Certified Diabetes Educator) and in her free time she also runs The Grand Bahamas Diabetes Education group on Facebook. She is a Super D Woman in my eyes!!!! Able to leap tall buildings in one leap!!!

Ahhh, there's nothing like life in The Bahamas

My main goal in meeting up with Christine was to present her officially with the blue circle pin, as part of the Pin a Personality Campaign that was started last year by IDF for World Diabetes Day (held every year on November 14^th).  Even though I think she thought I was silly saying that she's “a personality”, I still think anyone who works in the public doing what she does.... is a personality in my eyes.  I felt very honoured to have meet her and knowing how valuable she is to the community in educating diabetes.

She herself has Type 1 diabetes, which she feels was brought on by her autoimmune system being compromised by drugs that she had to take for a condition called Recurrent Respiratory Papillomas (RPP). She had numerous surgeries to remove the tumors from her respiratory tract (leaving her with a whispery sexy voice  ... or at least that’s my take on it <lol>).  If she hadn't had the surgeries, she would have died of suffocation. The good thing though is that she is one of the lucky ones, having been in remission for a long time.  And of all days, as I post this blog, on February 28th … it is the RareDisease Day celebrated all over the world to raise awareness amongst the general public and decision-makers about rare diseases and their impact on patients' lives. 

Before meeting up with Christine though, since she was working until 1:00 that day, I sauntered around some of the ports shops outside the port, talking to some of the locals.  This is the best part of travelling for me, speaking to locals, finding out what makes them tick, and sometimes finding some of the best deals that the locals go to (and not the tourists).  What became clear to me, and more so after meeting up with Christine.  Bahamas is in dire need of proper education in the diabetes sector.

I was talking to one shop owner, and of course, in my excitement I told her I was meeting up with Christine later that day and that I had had Type 1 diabetes since 1967 (I am such a blurter out person about my diabetes aren't I?). 

She told me that she was a Type 2 diabetic, but after speaking with her, clearly to my unmedical eyes/ears, she was a Type 1.  She'd basically been put on insulin right from the start.  The scary part was she didn't know how to use her insulin, or what it exactly does.  She relayed the story of having a 400 mg/dl (22 mmol/l) blood sugar reading the day before, and “being oh so ever thirsty” and that she’d drank orange juice (OJ)!!!  I told her that OJ has sugar in it, and it would only make matters worse.  She seemed to understand this, but to make her feel not so bad, , I said she could always have put a dash of OJ in the water, to make it taste less boring than just plain water, but to try to drink just plain water and to give some fast acting insulin. 

My DH in the back listening to Christine and I yaaking about diabetes and life in The Bahamas 

Fast acting insulin? She did she not know how to correct her blood sugar with fast acting insulin or really what it was (I explained to how I gave one insulin for food, and another type of insulin for just keeping my blood sugars level).   I could see this was beyond her comprehension but the good thing is she told me she wished she knew these things.  That's when I told her that the same day I was visiting, a meeting at the hospital was taking place, that Christine runs every Tuesday at 7:00, and that if she could – she might want to attend.  She had heard about these meetings, and said she would go. I left hoping she did.

As I went around, I came across others with similar stories.  One store owner, an American who had married a Bahamian, knew about this lady having the high blood sugar and like myself, knew that treating it with orange juice was a no no.

Crikey, she's driving on the WRONG side of the road :)

Finally it was time to meet up Christine (I was worried we wouldn't meet since I had had no data or mobile since we’d left Miami a few days prior).  Luckily, Freeport isn't that big and I was wearing my smoking cat t-shirt as promised so she could spot me in a crowd. Just when I’d sent my darling husband (DH) to scout the public parking lot, who zooms up in their car but Christine!!!  She came out of her car, and I was soooo excited.  We hugged each like we'd known each other for ever!!!  Oh, I’m such an emotional twit aren't I?

Sock Monkey sampling the local brew of The Bahamas - what a trooper

She drove us to a nice quiet area of the island, far away from the floating city folks that were on the boat with us ... and we just chilled out and talked about diabetic education in the islands.  One thing that really got to me,  as of January 1st - VAT (ValueAdded Tax) is now placed on drugs in The Bahamas.  The minimum wage on the islands is barely enough to pay rent and purchase drugs.  Plus most do not have a private insurance like Americans do or a government plan - but that is in the works - but when it will happen who knows.  So, with the 7.5% VAT added, for some people, balancing their income to purchase insulin, etc. is difficult.  

Luckily, the cost of insulin though is not as highly overpriced as it is in the USA; the islands seem to sell their insulin and other medical supplies similar to how we have it set up here in Canada.  Maybe this is due to Bahamas and Canada being an independent Commonwealth realm (we both retain Queen Elizabeth's II as our monarch) - so we follow somewhat same government, but I'm no expert in this area.

Presenting Christine with the blue circle pin which one day will hopefully be the universally recognized symbol of diabetes awareness (I mean who doesn't love blue?). 

So, over a few beers (Christine is gluten free - so she had unsweetened ice tea) - we had a good time planning adventures for educating within The Bahamas ... and hopefully meeting up at the IDF World Diabetes Congress  in Vancouver this November where I'll be working as a volunteer again and cracking the brains of doctors / researchers / you name it I'll delve into many subjects! 

The only one drawback of the whole meeting?  Time flew by way too fast.  Before we knew it, we were speeding off to get back to the port to catch our cruise ship that was going to the next port (Nassau).  Quick hugs, running to the gates to get back on the ship (we were about 10 minutes late for passengers to get back on) - what a rush!!!  For the first time, we were part of the entertainment for folks watching us from the ship, being the last passengers on (hmmm, wonder if they paged our names a few times)!!!  Thank goodness I can run like a crazed woman when I have to ... with Sock Monkey screaming in my ear - go go go!!  Of course,forgetting what I educate other diabetics I mentor, I did not bring any spare insulin with me, etc. but then, if I'd been stranded on the island ... I had Superwoman Pharmacist Christine to help me out for my legal drugs ;) 

Till we meet again Christine and the folks in The Bahamas!!!  Who knows, maybe that dream of living in the islands will be coming faster than planned ... we can be the Team D Crusaders - sailing to various islands in the Exumas / Abacos...  have insulin ... will travel!!!

You can view more of my blogs at Diabetes1.org ... my first blog on this recent R&R can be found at this link ... thanks for reading my fluff (Sock Monkey made me say this).

The Antidote - August 10th from 5-7 PM - Northampton, MA

Have nothing better to do on a warm summer night?  Do you feel like being an audience member or a participant?  If you're wondering where I'm going with this - check out the BLOG I posted  the other day at Diabetes1.org - Ms. Heffern is looking for T1D's to fill up a dinner table (5 course meal - I'll be there - what more can you ask for?).

I've attended this event before - back in July 2011 - it was a blast - helping to educate the audience members about what Type 1 Diabetes (T1D) is all about - no acting required - it's just sitting back - at a great meal (being served to you - now how often do you get this at home?) - and chatting away to others at the table.

Hope to see you there - it'll be well worth the 5 hour drive from Montreal to see you all.  I'm making a weekend trip of it due to the distance - mini-break for myself and my DH - who will also be at the head table - so you can grill him with questions as to "is she really as wild & crazy as she seems after being on the juice of life for almost 50 years???"