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The High Burden Of In-hospital Diabetes Mellitus At A Tertiary Care Hospital In Sri Lanka; A Case Control Study

1Senior Lecturer in Medicine, Department of Medicine, University of Peradeniya, Sri Lanka 2Senior Registrar in Medicine, Professorial Medical Unit, Teaching Hospital Peradeniya, Sri Lanka 3Temporary Lecturer, Faculty of Medicine, Department of Medicine, University of Peradeniya, Sri Lanka Citation: Medagama AB, Bandara R, Wijetunge R (2015) The High Burden of In-Hospital Diabetes Mellitus at A Tertiary Care Hospital in Sri Lanka; A Case Control Study. J Diabetes Metab 6:502. doi: 10.4172/2155-6156.1000502 Copyright: © 2015 Medagama AB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Background: Sri Lanka has a very high prevalence of diabetes with poorly organized diabetes care and limited resources for in-patient management. At present, 10.3% of the population is diabetic. Aim: The aim of this study was to define the reasons for admission of diabetic patients to a tertiary care general medical unit, to calculate Continue reading >>

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  1. wiley6coyote

    1 I am appalled at the lack of knowledge surronding care of long term diabetics when admitted to hospital for conditions unrelated ie. heart attack. A friend of mine almost died this week because his BS was allowed to drop to 1.3( canadian ) !!!! not once but 4 times in the span of a week. Long standing insulin doses which these people/or their families have been using/adjusting all their lives are thrown out the window and the hospital staff change up everything including diets etc. CBS are not monitored properly - my friend's wife asked that staff check his CBS when she was there and was told " its not ordered to be checked until 4 hours later". I have also witnessed a hypoglycemic situation being treated with 2 PB &J sandwiches, 2 OJ's with 2 pkg sugar and a banana- so that the patients' BS was then over 27!! How scary is this? These are registered staff - who were supposedly educated or at the very least should have policies and procedures set. What to do??? Family have to almost stay in the hospital and take over this aspect of care.

  2. CDEWannaBe

    What you observed wiley is a common occurence that threatens the health of many diabetics and even kills some while they are in the hospital.
    The lack of knowledge many healthcare workers have about diabetes is shockingly inadequate, outdated, and often completely wrong. Diabetes is different than most diseases because patients dose their own medication and also learn how their blood sugar is affected by different variables, so the patients quickly becomes an expert in their own disease. Some physicians and nurses are threatened by that.
    In my own experience, when I was in the hospital a few years ago to give birth (after having a healthy pregnancy and a 5.1 A1c with no lows), my OBGYN promised he would put in my chart that I could test using my own meter and administer my own insulin, but failed to do so. The nurses had orders to give insulin as prescribed. There were times when I had to refuse because I knew it would cause a severe low and instead of just calling the doctor and charting it, on 2 occasions the nurses told me I was a terrible mother and non-compiant diabetic! I was not non-compliant, I just was not willing to put myself into hypoglycemia in order to to do what someone had charted. And I was right each time.
    Just as I should have been. After all, I've had type 1 diabetes for 36 years, which in effect means I have 314,496 "clinical hours" managing it. I have been blessed to have expert doctors (Donnel Etzweiler from Park Nicolett and later Peter Chase from the Barbara Davis Center for Childhood Diabetes) and am a reasonably intelligent person. But I have repeatedly been treated like I am either uneducated or non-compliant anytime I have questioned the advice of a medical professional, whether in the hospital or anywhere else.
    My experience is not unique.
    Now I know there are non-compliant patients or those who are working off bad information (the other day my dad-in-law who has type 2 told me his endo told him to eat bananas, but I said he should double check because they're so carb heavy). But the truth is if you take a minute to hear what the patient is saying, you can usually weed out those who are concerned for their health and are trying to share valuable information they know about their disease and those who just don't want to take a shot.

  3. Tatinha

    OP is right. I have seen and have experienced myself all of the misconceptions and really bad information nurses and the healthcare personal have about diabetes. Just to mention a few: patients being offered a lasagna, and a large bowl of carrots with a regular soda for lunch (result: patient was irate and could not comprehend how a hospital could serve such unbalanced diet). pt admitted for nausea, glucose at 170 given dextrose 5% 100 ml/hr.( I understand they are afraid o lows, pt was NPO, but can you just check the sugars more often? result.. sugars went sky high!). another....patient complaining of nausea, type I, sent back home with no work-up. Came back 1 hr later, dehydrated and in full blown DKA. You can beg for a endocrinologist, but nothing is ever done. Although once, I was admitted myself and the doctor told me to keep using my own insulin and sliding scale since they did not have Novolog on the floor(I really appreciate that and give applause's to this smart and nice doctor). That proves not all of our healthcare are stuck in the past of diabetes, or do not understand it.

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Diabetes Patients Develop Preventable Complications In Hospital And Access To Specialist Staff Is 'inadequate'

Clinical audit shows patient care improving, but there is 'a great deal more to do' June 26, 2014: Over a fifth (22.0 per cent) of patients with diabetes in hospital will have experienced a largely avoidable hypoglycaemic episode6 in hospital within the past seven days, according to a national audit report released today. One in ten (9.3 per cent) will have experienced a severe hypoglycaemic episode and one in 50 (2.2 per cent) required injectable treatment due to the severity of the hypoglycaemia. This is despite the fact that only 8.1 per cent of respondents had been admitted for their diabetes or a diabetic complication. The findings are published today in the National Diabetes Inpatient Audit (NaDIA), carried out by the Health and Social Care Information Centre, in collaboration with Diabetes UK. NaDIA is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme3 The report found that over a third of inpatients (37.5 per cent) who should have been referred to a hospital diabetes team did not see a diabetes specialist8; almost one third (31.7 per cent) of sites in the audit had no diabetes inpatient specialist nurses ( Continue reading >>

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Popular Questions

  1. wiley6coyote

    1 I am appalled at the lack of knowledge surronding care of long term diabetics when admitted to hospital for conditions unrelated ie. heart attack. A friend of mine almost died this week because his BS was allowed to drop to 1.3( canadian ) !!!! not once but 4 times in the span of a week. Long standing insulin doses which these people/or their families have been using/adjusting all their lives are thrown out the window and the hospital staff change up everything including diets etc. CBS are not monitored properly - my friend's wife asked that staff check his CBS when she was there and was told " its not ordered to be checked until 4 hours later". I have also witnessed a hypoglycemic situation being treated with 2 PB &J sandwiches, 2 OJ's with 2 pkg sugar and a banana- so that the patients' BS was then over 27!! How scary is this? These are registered staff - who were supposedly educated or at the very least should have policies and procedures set. What to do??? Family have to almost stay in the hospital and take over this aspect of care.

  2. CDEWannaBe

    What you observed wiley is a common occurence that threatens the health of many diabetics and even kills some while they are in the hospital.
    The lack of knowledge many healthcare workers have about diabetes is shockingly inadequate, outdated, and often completely wrong. Diabetes is different than most diseases because patients dose their own medication and also learn how their blood sugar is affected by different variables, so the patients quickly becomes an expert in their own disease. Some physicians and nurses are threatened by that.
    In my own experience, when I was in the hospital a few years ago to give birth (after having a healthy pregnancy and a 5.1 A1c with no lows), my OBGYN promised he would put in my chart that I could test using my own meter and administer my own insulin, but failed to do so. The nurses had orders to give insulin as prescribed. There were times when I had to refuse because I knew it would cause a severe low and instead of just calling the doctor and charting it, on 2 occasions the nurses told me I was a terrible mother and non-compiant diabetic! I was not non-compliant, I just was not willing to put myself into hypoglycemia in order to to do what someone had charted. And I was right each time.
    Just as I should have been. After all, I've had type 1 diabetes for 36 years, which in effect means I have 314,496 "clinical hours" managing it. I have been blessed to have expert doctors (Donnel Etzweiler from Park Nicolett and later Peter Chase from the Barbara Davis Center for Childhood Diabetes) and am a reasonably intelligent person. But I have repeatedly been treated like I am either uneducated or non-compliant anytime I have questioned the advice of a medical professional, whether in the hospital or anywhere else.
    My experience is not unique.
    Now I know there are non-compliant patients or those who are working off bad information (the other day my dad-in-law who has type 2 told me his endo told him to eat bananas, but I said he should double check because they're so carb heavy). But the truth is if you take a minute to hear what the patient is saying, you can usually weed out those who are concerned for their health and are trying to share valuable information they know about their disease and those who just don't want to take a shot.

  3. Tatinha

    OP is right. I have seen and have experienced myself all of the misconceptions and really bad information nurses and the healthcare personal have about diabetes. Just to mention a few: patients being offered a lasagna, and a large bowl of carrots with a regular soda for lunch (result: patient was irate and could not comprehend how a hospital could serve such unbalanced diet). pt admitted for nausea, glucose at 170 given dextrose 5% 100 ml/hr.( I understand they are afraid o lows, pt was NPO, but can you just check the sugars more often? result.. sugars went sky high!). another....patient complaining of nausea, type I, sent back home with no work-up. Came back 1 hr later, dehydrated and in full blown DKA. You can beg for a endocrinologist, but nothing is ever done. Although once, I was admitted myself and the doctor told me to keep using my own insulin and sliding scale since they did not have Novolog on the floor(I really appreciate that and give applause's to this smart and nice doctor). That proves not all of our healthcare are stuck in the past of diabetes, or do not understand it.

  4. -> Continue reading
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Management Of Type 1 Diabetes In The Hospital Setting

Abstract The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings. Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described. Due to the increased prevalence and life expectancy of patients with type 1 diabetes, a growing number of these patients require hospitalization every year. Inpatient diabetes management is complex and is best provided by a multidisciplinary diabetes team. In the absence of such resource, providers and health care staff must become familiar with the features of this condition to avoid complications such as severe hyperglycemia, ketoacidosis, hypoglycemia, or glycemic variability. We reviewed most recent guidelines and relevant literature in the topic to provide practical recommendations for the inpatient management of patients with T1D. Notes Carl Continue reading >>

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Popular Questions

  1. wiley6coyote

    1 I am appalled at the lack of knowledge surronding care of long term diabetics when admitted to hospital for conditions unrelated ie. heart attack. A friend of mine almost died this week because his BS was allowed to drop to 1.3( canadian ) !!!! not once but 4 times in the span of a week. Long standing insulin doses which these people/or their families have been using/adjusting all their lives are thrown out the window and the hospital staff change up everything including diets etc. CBS are not monitored properly - my friend's wife asked that staff check his CBS when she was there and was told " its not ordered to be checked until 4 hours later". I have also witnessed a hypoglycemic situation being treated with 2 PB &J sandwiches, 2 OJ's with 2 pkg sugar and a banana- so that the patients' BS was then over 27!! How scary is this? These are registered staff - who were supposedly educated or at the very least should have policies and procedures set. What to do??? Family have to almost stay in the hospital and take over this aspect of care.

  2. CDEWannaBe

    What you observed wiley is a common occurence that threatens the health of many diabetics and even kills some while they are in the hospital.
    The lack of knowledge many healthcare workers have about diabetes is shockingly inadequate, outdated, and often completely wrong. Diabetes is different than most diseases because patients dose their own medication and also learn how their blood sugar is affected by different variables, so the patients quickly becomes an expert in their own disease. Some physicians and nurses are threatened by that.
    In my own experience, when I was in the hospital a few years ago to give birth (after having a healthy pregnancy and a 5.1 A1c with no lows), my OBGYN promised he would put in my chart that I could test using my own meter and administer my own insulin, but failed to do so. The nurses had orders to give insulin as prescribed. There were times when I had to refuse because I knew it would cause a severe low and instead of just calling the doctor and charting it, on 2 occasions the nurses told me I was a terrible mother and non-compiant diabetic! I was not non-compliant, I just was not willing to put myself into hypoglycemia in order to to do what someone had charted. And I was right each time.
    Just as I should have been. After all, I've had type 1 diabetes for 36 years, which in effect means I have 314,496 "clinical hours" managing it. I have been blessed to have expert doctors (Donnel Etzweiler from Park Nicolett and later Peter Chase from the Barbara Davis Center for Childhood Diabetes) and am a reasonably intelligent person. But I have repeatedly been treated like I am either uneducated or non-compliant anytime I have questioned the advice of a medical professional, whether in the hospital or anywhere else.
    My experience is not unique.
    Now I know there are non-compliant patients or those who are working off bad information (the other day my dad-in-law who has type 2 told me his endo told him to eat bananas, but I said he should double check because they're so carb heavy). But the truth is if you take a minute to hear what the patient is saying, you can usually weed out those who are concerned for their health and are trying to share valuable information they know about their disease and those who just don't want to take a shot.

  3. Tatinha

    OP is right. I have seen and have experienced myself all of the misconceptions and really bad information nurses and the healthcare personal have about diabetes. Just to mention a few: patients being offered a lasagna, and a large bowl of carrots with a regular soda for lunch (result: patient was irate and could not comprehend how a hospital could serve such unbalanced diet). pt admitted for nausea, glucose at 170 given dextrose 5% 100 ml/hr.( I understand they are afraid o lows, pt was NPO, but can you just check the sugars more often? result.. sugars went sky high!). another....patient complaining of nausea, type I, sent back home with no work-up. Came back 1 hr later, dehydrated and in full blown DKA. You can beg for a endocrinologist, but nothing is ever done. Although once, I was admitted myself and the doctor told me to keep using my own insulin and sliding scale since they did not have Novolog on the floor(I really appreciate that and give applause's to this smart and nice doctor). That proves not all of our healthcare are stuck in the past of diabetes, or do not understand it.

  4. -> Continue reading
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