I was looking for many years what protocol used by doctors in hospital, and why in hospital every time my insulin injections stopped. It is told all the time that insulin should not be stopped. IThios action can lead to death.
If it was I who look at the treatment patient in hospital then I would recommend, if patient come to hospital with BG> 140mg/dl, more obvious it is fasting level because of ill people usually fast rather then overeat, to start to use insulin therapy right away, regardless of any other medical conditions. In diabetes if BG is high then other medical conditions are difficult to manage. Very often they are the consequence of poor BG management.
But I am not doctor. So, millions of diabetics live without being diagnosed with diabetes, and only when condition is critical they are in hospital to get last medical though.
There are millions of pages how to recommend, and how to use recommendations, but at the bottom line there is diabetic and MD, only two if us, and Death between.
All what I do see in these recommendations, all those authors have recommend to us to be healthy, wealthy, and young. They have no one idea how to treat un-healthy people, those who are ill.
This is why I do not go to hospital when sugar is too high or too low. They are easy to kill, no responsibility or any protection of diabetics in hospital, the same as everywhere. At home I can take chicken brow when I hungry, and survive. The matter of fact, to decrease diabetics population it is best way to admit diabetics type 2 in hospital as often as it is possible.
Hyperglycemia is a common, serious, and costly health care problem in hospitalized patients. Observational and randomized controlled studies indicate that improvement in glycemic control results in lower rates of hospital complications in general medicine and surgery patients. Implementing a standardized sc insulin order set promoting the use of scheduled basal and nutritional insulin therapy is a key intervention in the inpatient management of diabetes. We provide recommendations for practical, achievable, and safe glycemic targets and describe protocols, procedures, and system improvements required to facilitate the achievement of glycemic goals in patients with hyperglycemia and diabetes admitted in non-critical care settings.
Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice GuidelineNow, what are recommendations?
https://academic.oup.com/jcem/article/97/1/16/2833111The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 1, 1 January 2012, Pages 16–38, https://doi.org/10.1210/jc.2011-2098Published:01 January 2012
3.1 We recommend a premeal glucose target of less than 140 mg/dl (7.8 mmol/liter) and a random BG of less than 180 mg/dl (10.0 mmol/liter) for the majority of hospitalized patients with non-critical illness. (1|⊕⊕○○)I did not get it, what are the point between 140 mg/dl and 180 mg/dl? This is the target to diagnose diabetes. But not in hospital. In hospital it is recommended that patient come with good blood sugar control. Otherwise what? Probably it is my misunderstanding, but for whom all these recommendations? and what does it mean they recommend?
If it was I who look at the treatment patient in hospital then I would recommend, if patient come to hospital with BG> 140mg/dl, more obvious it is fasting level because of ill people usually fast rather then overeat, to start to use insulin therapy right away, regardless of any other medical conditions. In diabetes if BG is high then other medical conditions are difficult to manage. Very often they are the consequence of poor BG management.
But I am not doctor. So, millions of diabetics live without being diagnosed with diabetes, and only when condition is critical they are in hospital to get last medical though.
3.3 For avoidance of hypoglycemia, we suggest that antidiabetic therapy be reassessed when BG values fall below 5.6 mmol/liter (100 mg/dl). Modification of glucose-lowering treatment is usually necessary when BG values are below 3.9 mmol/liter (70 mg/dl).Well, in this situation it is better to be aware of low blood sugar, and the actions to avoid the fall of BG down to the fatal level. It is easy to recommend to be healthy and wealthy, we all do know it is best. Still, we getting old, ill, and never wealthy. We are happy if our ends are met.What are those recommendations? What MD in hospital cross the street must to do when I am in ER? How to use these recommendations? I take 500 units insulin every day. If insulin stopped my sugar rise above critical level. If insulin delivered I got low blood sugar and sugar may be so low that it would be fatal.
There are millions of pages how to recommend, and how to use recommendations, but at the bottom line there is diabetic and MD, only two if us, and Death between.
All what I do see in these recommendations, all those authors have recommend to us to be healthy, wealthy, and young. They have no one idea how to treat un-healthy people, those who are ill.
4.1.1 We recommend that MNT be included as a component of the glycemic management program for all hospitalized patients with diabetes and hyperglycemia.These recommendations are all the time very well followed. Because of according to ADA Starvation is cure for diabetes type 2, hospital provide Starvation Diet to all its patients, regardless diabetes, high blood sugar or low blood sugar, or no sugar at all.
4.1.2 We suggest that providing meals with a consistent amount of carbohydrate at each meal can be useful in coordinating doses of rapid-acting insulin to carbohydrate ingestion.Did some one saw at any hospital that diabetic were on different diet then general patients? I did not. Usually I do have the same meal as everyone else. So, regardless of dose of rapid acting insulin we all do have the same amount on our plates.Probably it is the best. If meal is good in hospital then many will never leave it.
4.2.1 We recommend insulin therapy as the preferred method for achieving glycemic control in hospitalized patients with hyperglycemia.I posted many times, in hospital if sugar is high they will initiate insulin therapy. Sugar will drop. Patient go home to modify life style. No insulin. Just SU and Metformin and Starvation diet. It is all the time published that diabetics come to hospital too often. Why? Probably if diabetic will go home with Rx to insulin this diabetic will not be back in hospital one week later. A few visits to ER and next appointment to the Morgue would be provided.
4.2.3 We suggest that patients treated with insulin before admission have their insulin dose modified according to clinical status as a way of reducing the risk for hypoglycemia and hyperglycemia.It is easy to recommend, but really how to modify? Do not try to find any recommendations. This is why "individualization" is so important. Good cover to hide in safe place. Let someone take the risk to modify, and stay with recommendations. It is safe and honorable.
4.3.2 We suggest that prolonged use of sliding scale insulin (SSI) therapy be avoided as the sole method for glycemic control in hyperglycemic patients with history of diabetes during hospitalization.Why this method is not good? Because of in this case it is MD and hospital who will be blamed to low blood sugar. When diabetic use these recommendations at home, it is diabetic to be blamed for wrong use of insulin. Smart, very smart.
4.3.3 We recommend that scheduled sc insulin therapy consist of basal or intermediate-acting insulin given once or twice a day in combination with rapid- or short-acting insulin administered before meals in patients who are eating.Sorry, I did not get it. If I take 500 units daily dose of insulin then what dose of insulin would be injected at once? BTW, to take rapid acting insulin is very complicating. How combine two actions, insulin which will use all sugar I got from Starvation Diet, less then withing an hour, and then basal insulin demand more insulin. There is no meal, no sugar in blood.
This is why I do not go to hospital when sugar is too high or too low. They are easy to kill, no responsibility or any protection of diabetics in hospital, the same as everywhere. At home I can take chicken brow when I hungry, and survive. The matter of fact, to decrease diabetics population it is best way to admit diabetics type 2 in hospital as often as it is possible.
4.4.3 We recommend that patients and their family or caregivers receive both written and oral instructions regarding their glycemic management regimen at the time of hospital discharge. These instructions need to be clearly written in a manner that is understandable to the person who will administer these medications.What instructions they will give? That the cap on needle must be removed before injection of insulin will be given. What else they are able to recommend? Is patient discharged from hospital with good blood sugar A1c? No. Is patient must take the same dose of insulin as it was used in hospital? No. How regime of glycemic control was determined? Which regime diabetic must use, this one which was in hospital, or another one, which is not known? Instructions, recommendations, and it is diabetic who must know how to control blood sugar, the action no one MD or Endocrine Society able to determine. After that they all pretend, we are, diabetics type 2, so stupid that we need instructions how many spoons of soup we have to take with every meal.
via Ravenvoron
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