Advocating for better diabetes care in hospitals

When patients with diabetes end up in hospital to be treated for other conditions, they don’t always get all the care they need.

Barbara Morton, a partner in a global professional services firm in Calgary, has what she calls “type 4 diabetes.”

“I don’t have diabetes, but my two children and my husband have type 1,” she explains. “My sister also has type 1, and my dad and my father-in-law have type 2. So I have had a lot of experience caring for people with diabetes.”

Along the way, Ms. Morton has become an advocate for better diabetes care in hospitals.

Barbara Morton with her children and husband, who all have type 1 diabetes. 

Barbara Morton with her children and husband, who all have type 1 diabetes. 

Like many people with diabetes, her father also has heart disease and has been hospitalized for heart attacks and related surgeries. Her husband has a rare condition called brain hydrocephalus and has been hospitalized for several brain surgeries.

“I’ve found it to be quite frustrating,” she says. “He generally has great care around his brain issues, but there are real problems when people in hospital have diabetes as well as these serious problems.”

For example, on a number of occasions, nurses have given her husband a single injection of two insulins that are not supposed to be mixed, she reports. “They’re horrified when they find out. It’s not their fault in any way – they just don’t have the training they need to care for people with diabetes.”

Her father has had similarly dangerous experiences. Several times, when he experienced severe hypoglycemia, his nurse brought peanut butter and crackers even though it is essential to give juice first to get the blood glucose (sugar) level up before sustaining it with the peanut butter or other high-protein snacks, says Ms. Morton.

In addition, insulin injections to offset the glucose in a meal aren’t always given at the right time or matched to the quantity of food the patient eats. “My husband’s had this several times and so has my dad. They’re given the insulin, and then either they get their meal too late or can’t eat it because they don’t feel well. If no one is watching, they’re going to have low blood glucose (hypoglycemia). Or the meal comes and they need their insulin – but the nurse can’t come with the needle.”

Also frustrating is the fact that most nurses insist on using the hospital’s blood glucose testers even though people with diabetes almost always have their own testers with them, she says. If a test reveals that blood glucose is high, it is checked again 15 minutes later. If it is still high, blood work is ordered. “It’s very invasive. Adults understand that being in hospital comes with all kinds of uncomfortable moments, but what really horrifies me is that kids across Canada may be having blood draws unnecessarily.

“They have their own testers right there, which are sophisticated, less painful to use and very reliable. Blood testing through glucometers these days is routine, and patients shouldn’t be put through extra testing.”

Ms. Morton would like to see a higher level of endocrinologist involvement whenever a patient with diabetes is admitted. “Special attention must be given to the diabetes care required, and it should involve the family, the patient if he or she is capable, and an endocrinologist.”

She would also like to see more real-time diabetes resources for nurses. “As an accountant, if I have a question about some aspect of tax I don’t typically deal with, I reach out to an on-call service to consult with an expert. But nurses don’t seem to have the level of support that they need, and they don’t always have three or four hours or a day to wait to hear from a doctor.”

Your rights as a hospital patient with diabetes

A person living with diabetes has the right to receive quality medical care from competent health-care providers who know and follow accepted safety standards.

Hospital staff should respect a patient’s knowledge about their condition, and listen and act on their concerns if they think certain medical procedures (for instance, the timing of medications or meals) are putting them at risk.

As reported in the Clinical Practice Guidelines for the Management of Diabetes in Canada, blood glucose continues to be poorly controlled and is frequently overlooked in general medicine and surgery services. If you are concerned about your care or if you think your concerns are not being heard, ask for a meeting with the hospital’s patient representative or patient advocate.

For more information, please visit the Canadian Diabetes Association website to read the Guide to Being Hospitalized.