Diabetes Solution Revised and Updated 2007
A P P E N D I X B
Don't Permit Hospitalization or Lengthy Outpatient Procedures to Impair Your Blood Sugar Control
If ever it is necessary for you to become a hospital patient almost anywhere in the world, the chances are overwhelming that no reasonable thought will be given to controlling your blood sugar. Most of the medical orthodoxy doesn’t do it anywhere else, so why should they do it in the hospital?
The reasons for such neglect, of course, are many: lack of blood sugar control skills on the part of most hospital medical staff; unawareness of the importance of normal or near-normal blood sugars in the face of illness or surgery; and an almost pathological fear of severe hypoglycemia (and the potential for lawsuits in the United States if it occurs). Many if not most hospital dietitians have been indoctrinated by the ADA, with the result that diabetic inpatients are forced to eat high-carbohydrate foods and are deprived of protein and fat. Some of my patients tell stories of having to sneak in their own insulin and blood sugar meter, throw out hospital food, and fight tooth and nail with well-meaning but uninformed hospital personnel.
Many studies of hospitalized patients have demonstrated that elevated blood sugar delays surgical healing, increases risk of postsurgical morbidity and mortality, delays recovery from infections, and leaves patients open to new infection. It also has been shown to increase death rate of patients who have been hospitalized for heart attack or stroke, and increases the likelihood of a new stroke or heart attack.
What can you do to help keep your blood sugars under control while in the hospital?
After sharing the frustration of my patients over the years, I’ve come up with a letter that has worked repeatedly for elective hospitalization, such as for surgeries planned in advance. As you will see, it relies on the prevailing fear of litigation that appropriately permeates the medical care system in the United States. This letter should be sent by you or your diabetologist to the admitting physician, with a copy to the hospital administrator. I’ve composed the letter as if you were writing it, since the odds are that you are not under the care of a diabetologist. It can, of course, be modified to suit your circumstances.
Dear Dr. __________:
[List here doses, times, and purposes of medications: “basal insulin (or ISA) to cover the fasting state—must be given even if not eating,”“prelunch (breakfast, supper) insulin (or ISA), to be skipped if meal is skipped.”Detail also any use of insulin, glucose tablets, or liquid oral glucose for correcting off-target blood sugars, etc.You may also include a sample GLUCOGRAF sheet and request that all medications used by the hospital that may affect blood sugar be listed on it if you are not capable of listing them yourself.]
My hospital orders should call for a “normal diet” and not a “diabetic diet,” so that I can select my own meals.
Routine intravenous fluids should not contain caloric substances such as glucose, fructose, lactose, lactated Ringer’s solution, or saline with added glucose (except for treatment of blood sugars that are below my target). All of these substances will raise my blood sugar to unacceptable levels. Normal saline solution is perfectly adequate for routine hydration.My target blood sugar is ___ mg/dl. If I am conscious and without cognitive impairment, I should have full responsibility for treatment of my diabetes—without outside interference. My blood sugar meter and blood sugar control medications, including insulin syringes, should not be confiscated by hospital personnel. This is a barbaric practice that is rapidly being abandoned in modern hospitals.*
If I am unable to care for my own blood sugars, I expect that the hospital staff will exercise every effort to maintain my blood sugarswithin the range of [00–00].
cc: [Hospital administrator]
This letter may also be of value if you are to have certain outpatient procedures, such as endoscopy, cataract surgery, hernia repair, and so on. These are frequently performed in physicians’ offices or in hospitals without the requirement for staying overnight.
* Many hospital pharmacies do not stock the products that we commonly utilize
in this book, such as 25–30-unit insulin syringes with .-unit markings, detemir
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