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Re: [IP] Re: Overnight highs
I too had a dr. lie to me about an insulin dose while in the hospital.
I was in the hospital for knee surgery in 1982. My bg's were a bit
erratic, but I attributed that to the trauma of having every single
ligament in my knee reattached and some cartilage removed. (I was in a
cast for about 4 months).
The night after the surgery at about 10:00 p.m. my bg was running over
300. I was major league stressed out with pain from the knee. At that
time I was taking 3 shots of R (8 u. each), and 1 shot of NPH (20 u).
So here comes NURSE RATCHET (Remember the really mean nurse from 'One
Flew Over the Cookoo's Nest?' Well this was her evil twin), with a
syringe filled with 40 UNITS OF REGULAR INSULIN. Yeah, this nut case
said the dr. told her I needed to inject 40 UNITS OF REGULAR INSULIN at
10:00 p.m. at night to bring my bg down. At first tears swelled up in
my eyes as I thought about death. Then I decided I didn't want to die
and piped up: "But that's more regular insulin than I take in an entire
day!! That's not right." I refused to take the insulin. I told her I
would take 8 units at the most to bring down the high, but only if she
also placed food on my tray BEFORE I took the shot in case I needed it.
We argued for at least an hour. This woman was adamant. So she calls
the dr. and he absolutely insists that I take this 40 UNITS OF REGULAR
INSULIN AT 10:00 P.M. at night. Again I refused. I told her to call
the dr. at the clinic who treated my diabetes at that time. He agreed
with me, not the nurse. Anyway the Dr. who prescribed the DOSE OF
DEATH, comes to see me the next morning, and completely denies that he
gave the order of 40 units of regular at 10:00 p.m. I didn't believe
him. I figured what really happened is that the dr. who was treating my
diabetes, called this wacko and straightened him out, but Dr. Death
would not fess up his mistake to me. Good ole Nurse Ratchet was just
trying to follow dr.s' orders I suppose.
This time around was a whole new ball game. I had to have surgery on
the same knee again this past Tuesday. Thanks to all who responded to
my post with tips and information re: surgery and the pump. My
Orthopedic surgeon and Endo discussed how to manage the pump BEFORE
surgery. We adjusted my profiles for the day. My IV was SALINE, not
DEXTROSE. The highest bg that day was 178, just prior to the surgery.
I racked it up to a case of pre surgery nerves and memories of Nurse
Ratchet and Dr. Death in 1982. After surgery I was 135 and hovered
around that range for the rest of the day. Hey my knee still hurts like
hell, but my diabetes is still in good control thanks to the pump (and
no interference from personality types like Nurse Ratchet and Dr.
Boy, ya always gotta watch your back with this disease. Maybe we should
start a FAQ, good dr.'s/bad dr.'s how to tell them apart. We could
leave out the names to prevent slander suits. After reading posts from
others on this list, I know I'm not the only person who has run into a
real life Nurse Ratchet and Dr. Death.
Hopping around and enjoying my pain pills,
> In a message dated 98-04-12 10:01:43 EDT, Ted wrote:
> A hypo at 3:00 AM can lead to the Symogyi Effect, where your
> > emergency response to the low will dump a lot of glycogen (which ends up
> > making glucose) from the liver to save your life, but it's almost ALWAYS too
> much. This leaves you with a high in the morning NOT based on too MUCH bg
> during the night, but too LITTLE.
> I had just changed doctors must have been around 91 or so and he put me in the
> hospital for a week's worth of poking, prodding and education - aka being
> "regulated." For the first 2-3 days they decided how much insulin, what I
> ate, etc - and didn't let me work out at all, even though at that time I was
> working out 2 hours a day, 6 days a week (aerobics, bike and weight
> lifting),,,but whatever. I kept waking up in the morning with high blood
> sugars...At 9 I was fine, at 12am I was fine, at 4am I was fine, but at 7am -
> way high. The doctor kept ordering higher and higher doses of night time NPH.
> Finally, about day 3, I asked him about this thing called "dawn effect" I had
> heard about (I was mistaking this for the Smoygi thing, but I was on the rigth
> track). He said "oh no no that wasn't it." I could not understand why my
> night time insulin was practically DOUBLE it had been before entering the
> hospital. That night the nurse brought my syringe - at that point they were
> drawing them up - hey I was paying em big bucks - let them do the work. It
> didn't look as full as it normally did and I asked if the doctor had lowered
> my NPH to see if I had the Smoygy effect - "oh no" said the nurse, "it is the
> same dose as last night. 8 units of R and 12 units of NPH" - I was skeptical
> but took it, looked at the markings, noting it did in fact say 20 units and
> shot it up
> Next morning, 7am, my bs was fine and the doc comes in and says "SEE you dont
> have the smoygy effect, you just needed more insulin." He then told me my
> night time dose of nph was from then on, 21 units.....I said (and not for the
> first or last time), "you are wrong. That is not what I got." I told him
> what the nurse said and that I had looked at the syringe and only got a total
> of 20 units. When I was checked at 12 midnight, I was OK, so I must have
> gotten the R. He said "I ordered 21 units of NPH last night." I told him
> someone must have dyslexia and that I would be taking 12 units again tonight
> to test this theory out. He storms out of the room and returns with my chart
> and puts it in front of me - "You got 21 units of nph insulin last night
> according to this chart." "well, someone LIED, then" I bellowed back - I was
> not Blind and I certainly was not stupid!
> So that night, I again took the 12 units of NPH...and was normal the next
> morning. My nurse that night came in all sheepish and kiss ass - oh I am so
> sorry I gave you the wrong insulin...blah blah blah. THANK god she did - 21
> units of NPH might have killed me!!!
> I figure I must have been going low from the dinner time NPH sometimes between
> 1am and 3am, and when they were checking at 4am, I was already rebounding with
> glycagen galore...passing thru normal on the way to outta sight...
> End of story. soon thereafter...end of doctor.
> who ever since did her own drawing up of insulin, and her own meter tests and
> her own poking when necessary, thank yew very much.
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