So English endocrinologist Partha Kar asked on twitter if self-administration of insulin is always appropriate.
It got me thinking, when ISN’T it appropriate? It seems to me that when you’re diagnosed with diabetes you get some fairly rudimentary education and then you’re sent home to calculate dosage and administer a potentially lethal drug. Multiple times a day, day-in-day out we do this.
So where do health care professionals get off declaring us incompetent to do this and denying us our basic rights when we are inpatients in hospital?Sure, if you’re unconscious or otherwise incapacitated then you will need help-but self-management should be the default position. Seems like common sense but anecdotes abound of patients being coerced out of their pumps, being denied insulin despite extremely high sugar levels and all sorts of other horrors. It’s not just anecdotes either, studies of diabetes management of diabetic inpatients are alarming.
The National Diabetes Inpatient Audit (NaDIA) found that, in a five-day period, more than 60 people with diabetes developed diabetic ketoacidosis (DKA), which results from a severe shortage of insulin. … Even a single case of DKA developing in hospital is unacceptable because it suggests that insulin has been withheld from that person for some time. The fact that this is regularly happening raises serious questions about the ability of hospitals to provide even the most basic level of diabetes care….
The report also found that the majority of hospitals in the survey made medication errors, with more than a third of inpatients experiencing a medication error during the period of the study.” A good summary of the findings can be found here. UK National Diabetes Inpatient Audit
This is crazy, amongst people with diabetes the word is to have a secret stash of insulin and food with you in hospital so that you can save yourself from the incompetency. If diabetes professionals worried half as much about the incompetency of their generalist colleagues as they did about wrestling control over insulin and food from people with diabetes, hospitals might be a safer place.
I’d like some legal advice, what are my rights here? Surely, if I want to I should be able to self-manage my diabetes UNLESS I am legally declared incompetent. So if I want my pump during surgery then I shouldn’t have to fight for it. I and 1000s of other people with diabetes shouldn’t have to fear being killed by medical incompetency or negligence.
My thoughts on this are still forming but why can’t we have something like a diabetes care directive, that details our total daily dose, correction logarithms and carb ratio for use if we are unconscious or declared legally incompetent by the Public Trustee. Failing this our right to manage our diabetes should be respected.
What do you think? What has been your experience?