I was admitted to Hospital on 25 July 2022 for hip replacement surgery, fixing the bung first surgery, it was a big operation, three hours, the surgeon saying there was a lot of damage. By 6:30 that night the surgery was completed and I was transferred to a ward and medications started. By morning I was extremely nauseous only managing to eat a couple of mouthfuls of food for breakfast, a few hours later I started vomiting. I assumed this nauseousness was due to the anaesthetic, advised the nurse and anti nausea medications were given. Over the next three days I could not eat due to extreme nauseousness, but continued vomiting.. By PM hours on the third day my stomach was empty, however I was still extremely nauseous and although my stomach was empty but I was now dry reaching. I noticed the nauseousness got worse after each antibiotic. At this point I asked for a change in antibiotic as it was obviously what was making me sick. The on call Doctor refused to change the antibiotic and advised the staff to continue with the current antibiotic. At this point I refused any further anti biotic treatment.
The next morning, my surgeon, attended at which point I advised him I had stopped the antibiotic medication and would be discharging that morning to seek appropriate treatment. I also advised him that going without food and vomiting continuously was not sustainable. The surgeon asked why I hadn’t advised him of this earlier. At the time I had no answer, however, in retrospect, I would ask ‘why haven’t you checked the nurses notes, if no one is reading the nurse’s notes, why do they bother taking them?’. Nevertheless, the surgeon then changed the antibiotic to a less aggressive one and I started feeling better, by the afternoon of the fourth day I was finally able to take in a few mouthfuls of food and discharged the following morning, although still very nauseous.
Diabetic control.
On admittance I advised all that I would be self administering diabetic control in the form of insulin. For the first couple of meals there were no problems, glycaemic level post operatively was in the vicinity of 20 mmol/L ((normal being between 4-6) which I had gradually started to decrease, carefully as I was not able to eat. Glycaemic level would go down to around 12/14 mmol/L, then rise again. When my glycaemic level rose to around 22mmol/L I ask for 15 units of insulin. However, at this time the nurse decided to consult the on call Doctor who advised insulin was to be withheld until I had eaten.
Experience over 23 years has told me that I should not eat with levels in excess of 20. Experience also told me that my glycaemic level would peak one hour after eating and that insulin has no effect on me until around 45-60 minutes after intake. So, had I eaten one sandwich, managed to keep it down, and injected the appropriate insulin dose immediately, my glycaemic level would have peaked in one hour to over 30 mmol/L before starting to decline. At high 30s, low 40s a diabetic can become comatose.
I demanded to see the Doctor and he eventually attended. A heated discussion ensued and he left advising the nurse to allow me 6 units of insulin. This was clearly no where near enough, it lowered my glycaemic level to 18 after a couple of hours and then it started to rise again. Not long after the Diabetic specialist attended and another heated discussion ensued. Eventually he left giving my diabetic control back to me. Over the next 12 hours or so, without food I managed to get my glycaemic level down to 7.5 mmol/L, however it kept rising so my level wavered between 8-14 for the remainder of my stay.
Many things affect glycaemic control post operatively: Medications, bodily stressors, mental stressors, anaesthetics and so on. Further, every diabetic is different, what effects one diabetic doesn’t necessarily affect another in the same way. I was diagnosed with slowly evolving type 1 diabetes 23 years ago and have been controlling it since then. 23 years experience has taught me how different foods affect my glycaemic levels, how activity affects my glycaemic levels, how different amounts and types of insulin affect my glycaemic control. Timing, insulin dosage, food intake and activity levels have to be taken into account when treating diabetes. I manage my diabetes by counting carbs and rely on experience gained over 23 years on how much insulin to inject for a given carb intake, taking intended activity levels into account.
To date I have been very successful, my HbA1c levels have been in the high sixes for a number of years, I no longer see a diabetic specialist and my GP is more than happy with my diabetic control.
I was made aware of the hospital’s diabetic protocols, however, those protocols clearly were not working and the on call Doctor ignored that fact, as well as the effect the antibiotics were having, but refused to change antibiotics even though they were having a negative effect on me.
Every hospital has a responsibility to provide their patients with a safe, appropriate, responsible and sensible level of treatment during their stay. Withholding necessary medications from a patient is in no way safe, and causing a patient to become ill during their stay without taking appropriate steps to resolve the problem is in no way responsible or sensible. The cornerstone of a patient/medical professional relationship, in my view, is for the medical professional to listen to the patient, without listening, there can be no understanding of the patient’s needs.
A very enjoyable stay that was, I came home 4kgs lighter.
[TH1]
The next morning, my surgeon, attended at which point I advised him I had stopped the antibiotic medication and would be discharging that morning to seek appropriate treatment. I also advised him that going without food and vomiting continuously was not sustainable. The surgeon asked why I hadn’t advised him of this earlier. At the time I had no answer, however, in retrospect, I would ask ‘why haven’t you checked the nurses notes, if no one is reading the nurse’s notes, why do they bother taking them?’. Nevertheless, the surgeon then changed the antibiotic to a less aggressive one and I started feeling better, by the afternoon of the fourth day I was finally able to take in a few mouthfuls of food and discharged the following morning, although still very nauseous.
Diabetic control.
On admittance I advised all that I would be self administering diabetic control in the form of insulin. For the first couple of meals there were no problems, glycaemic level post operatively was in the vicinity of 20 mmol/L ((normal being between 4-6) which I had gradually started to decrease, carefully as I was not able to eat. Glycaemic level would go down to around 12/14 mmol/L, then rise again. When my glycaemic level rose to around 22mmol/L I ask for 15 units of insulin. However, at this time the nurse decided to consult the on call Doctor who advised insulin was to be withheld until I had eaten.
Experience over 23 years has told me that I should not eat with levels in excess of 20. Experience also told me that my glycaemic level would peak one hour after eating and that insulin has no effect on me until around 45-60 minutes after intake. So, had I eaten one sandwich, managed to keep it down, and injected the appropriate insulin dose immediately, my glycaemic level would have peaked in one hour to over 30 mmol/L before starting to decline. At high 30s, low 40s a diabetic can become comatose.
I demanded to see the Doctor and he eventually attended. A heated discussion ensued and he left advising the nurse to allow me 6 units of insulin. This was clearly no where near enough, it lowered my glycaemic level to 18 after a couple of hours and then it started to rise again. Not long after the Diabetic specialist attended and another heated discussion ensued. Eventually he left giving my diabetic control back to me. Over the next 12 hours or so, without food I managed to get my glycaemic level down to 7.5 mmol/L, however it kept rising so my level wavered between 8-14 for the remainder of my stay.
Many things affect glycaemic control post operatively: Medications, bodily stressors, mental stressors, anaesthetics and so on. Further, every diabetic is different, what effects one diabetic doesn’t necessarily affect another in the same way. I was diagnosed with slowly evolving type 1 diabetes 23 years ago and have been controlling it since then. 23 years experience has taught me how different foods affect my glycaemic levels, how activity affects my glycaemic levels, how different amounts and types of insulin affect my glycaemic control. Timing, insulin dosage, food intake and activity levels have to be taken into account when treating diabetes. I manage my diabetes by counting carbs and rely on experience gained over 23 years on how much insulin to inject for a given carb intake, taking intended activity levels into account.
To date I have been very successful, my HbA1c levels have been in the high sixes for a number of years, I no longer see a diabetic specialist and my GP is more than happy with my diabetic control.
I was made aware of the hospital’s diabetic protocols, however, those protocols clearly were not working and the on call Doctor ignored that fact, as well as the effect the antibiotics were having, but refused to change antibiotics even though they were having a negative effect on me.
Every hospital has a responsibility to provide their patients with a safe, appropriate, responsible and sensible level of treatment during their stay. Withholding necessary medications from a patient is in no way safe, and causing a patient to become ill during their stay without taking appropriate steps to resolve the problem is in no way responsible or sensible. The cornerstone of a patient/medical professional relationship, in my view, is for the medical professional to listen to the patient, without listening, there can be no understanding of the patient’s needs.
A very enjoyable stay that was, I came home 4kgs lighter.
[TH1]