Time for Hospital?

It happens. We all get to the point with our health that we need to go to hospital.

Having diabetes does not necessarily mean you will be sick more often than someone without diabetes.

Having diabetes does however increase your risk of needing a hospitalisation.

So, when is it time to go to hospital?

Situation 1

John is unwell. He is experiencing fever; headaches; lethargy. He has a viral infection: the common cold.

Being unwell may lead to the following possibilities:

1. not eating your usual foods, reduced appetite
2. maybe not drinking enough fluids > dehydration > increase in BGL
3. less physical activity than usual > increase in BGL

John has type 1 diabetes – he puts his “Sick Day Plan’ into action.

The Plan

The basics of John’s sick day plan look like this:

1. Take usual doses of insulin: DO NOT skip insulin
2. Measure blood glucose levels more often – each 2-4 hours
3. If BGL over 15mmols John checks for ketones: his plan involves giving more insulin if ketones are present, or if his BGL is over 15mmols (to reduce the risk of ketone bodies forming)
4. Maintain hydration: drink unsweetened fluids frequently if BGL over 15mmols; drink sweetened fluids if BGL under 15mmols and unable to eat normally ie maintain some carbohydrate intake

So, John follows his plan.

John has slept in longer than usual. At 10am his BGL is 14.7mmols and he has a fever. John knows this is higher than usual, so he increases his usual pre breakfast his insulin dose to compensate for this.

John feels unable to eat breakfast, so he drinks some fluid that contains his usual breakfast volume of carbohydrates.

At 12 noon John measure his BGL: still 14.7mmols. He realises his meter (like all BGL meters) is not 100% accurate, and that his plan involves checking for ketones when the BGL is over 15mmols. John is now increasing his risk of ketoacidosis, so he checks for ketones: positive.

Time to go to hospital? No, John can manage this. He is experienced and has a good plan to follow. The plan was developed in collaboration between himself and his diabetes educator and endocrinologist.

John gives himself a dose of insulin and takes some Panadol for the fever.

At 2pm John checks his BGL and it is now 17.5mmols. His ketone check finds a positive result again.

The safest thing for John to do is go to hospital. He knows he could try and take some more insulin to clear the ketones, but is still feverish and has no support at home with him. He is now unable to be safe at home, and rather than wait for things to get worse he calls for help and goes to hospital.

Options?

What other options could John have considered here?

 

Situation 2

Renee loves the gym. She exercises every day. Today she is running late.

Today Renee misses her afternoon snack and heads straight in to the gym for her session of aerobics.

Renee has type 2 diabetes. Renee uses tablet medication for her diabetes.

About 15 minutes into the session Renee feels light headed and dizzy. Renee has no hypo treatment with her in the gym. Renee keeps going with the exercises. Renee keeps her hypo treatment in her car.

The instructor sees that Renee is struggling and stops the session. Renee is looking unwell and is beginning to not make any sense in her responses to the instructor’s questions. The instructor calls for an ambulance to take Renee to hospital.

Renee is having a hypo. Renee did not tell the gym that she has diabetes. She heard through a friend that she would not ne able to continue with this gym if she told them that she has diabetes.

Options?

What other options could Renee or the gym instructor have considered here?

 

Situation 3

Ignatius is a contractor, a driver of heavy machinery building roads. Ignatius has type 2 diabetes. Ignatius has a wound on his foot that has been present for several weeks.

Ignatius’s wound was caused by a metal plate where he rests his foot when driving the machinery. Daily, the pressure on his foot prevents his wound from healing.

One evening Ignatius’s wife notices a nasty smell. It is Ignatius’s foot.

She suggests he goes to hospital as the tissue around the wound looks black and very nasty. She has heard about gangrene, but until now has no idea what it looks like.

 

Options?

What other options could Ignatius have considered here?

Posted by David – Diabetes Educator @ Diabetes Counselling Online