When I had elective surgery a year and one-half ago and then when I had an emergency operation about six months ago, I told the hospital that I wanted them to provide me with a diabetes diet. Big mistake. They have no idea what a proper diabetes diet is.
At that time I had read the book by Richard K. Bernstein, M.D., Dr. Bernstein’s Diabetes Solution. But I hadn’t focused on his guide to hospitalization. You can be sure that if I have a chance, the next time a hospital tries to run my diabetes life, I will guide it with a letter to them like the one here.
This week he told me that I was free to reproduce that guide here. What happened was this.
One of the regular readers of my articles here sent me a copy of a letter that she had written protesting the awful treatment that she had received in a hospital in Wyoming and in another hospital in Colorado. She wanted to get the letter to Dr. Bernstein, who she and I both look to for guidance on controlling our diabetes.
When I passed on her letter to him, Dr. Bernstein was sympathetic. But he added that he gets even worse horror stories from other people who run into our American health care system.
“They all relate to the ignorance and lack of compassion of physicians and hospital personnel,” he said. “I asked my literary agent if we should transcribe them for a book. I was told that people don’t want to read depressing stories, and no publisher would be interested. If you think this kind of thing would serve a purpose on your blog, just post a request for stories about interactions with medical personnel and you’ll be overwhelmed.”
Then, in a follow-up message Dr. Bernstein added that, “I warn people about this in appendix B of my book. If you want to publish that appendix in your blog, you may.”
So here goes:
APPENDIX 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?
Most of my patients live great distances from my office, so that I am not the admitting physician or surgeon when they are hospitalized, and I am thus not in a position to write their orders, help control their diets, and directly oversee their medical care.
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. __________:
I am scheduled for admission to your hospital on __________. I have type [1 or 2] diabetes and am naturally concerned about control of my blood sugars while hospitalized.
It is now generally accepted that elevated blood sugar levels impede recovery, prolong hospitalization, and increase the incidence of hospital and surgical morbidity and death. Major health problems brought about by inappropriate blood sugar elevations during hospitalization have justifiably led to litigation.
Since I have been successful at keeping my blood sugars essentially normal around the clock, I naturally expect equivalent care while I’m in the hands of medical professionals.
I currently take the following medications for controlling my blood sugars:
[List here doses, times, and purposes of medication: “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 sugars within the range of [00-00].
Sincerely, cc: [Hospital administrator]
[Close relative or friend]
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 1/2–unit markings, detemir (Levemir) or glargine (Lantus) insulins, and lispro (Humalog) or aspart (Novolog) insulins.