I went to A&E (the ER for you American readers) earlier this month. But before I get to why, I must briefly tell you about when I was diagnosed with diabetes. Four years ago this month, a few days after Christmas, I presented myself to an out of hours doctors service with symptoms resembling what my brother had when he was diagnosed nineteen and a half years previously. I was sent to A&E when my blood sugar and ketones were very high. I remember the staff in the hospital never made me feel any stress or trauma even as I was awake through the night while I was looked after all night. I took it all in my stride because of how the staff took care of me. The only uncomfortable experience was I had to try and call a nurse or wait for one to pass by when I needed the toilet. I had to pee in a plastic jug because I was hooked up to a saline drip and insulin and couldn't haul them to the toilet with me as they were on a set system to administer it.
Fast forward to one of my Diabetes nurse appointments and she told me if my ketones get above 1.6 to call a doctor. If they get above 2 go the hospital. Now back to earlier this month. A colleague and I were sent home early from work because we were both unwell and looking very pale on a Wednesday morning. I tested my Ketones that morning with the intention of calling in sick if they were high. They read 0.1 so I went in only to be sent home later that morning anyway. I phoned in sick with flu the following morning. I couldn't get a doctor appointment on the Thursday or Friday and the out of hours service were not answering calls. My blood sugar was in the 12s (that's around 180mg/dl for those that don't measure mmol/l) even though I wasn't eating. On Friday night they went up above 14 and ketones to 2.0. I made a call for an ambulance on Saturday morning. I was told they'd be hours because they were very busy and the roads were treacherous due to ice and sub zero Celsius temperatures. I cancelled the ambulance and made my way into the town centre to look for a taxi. None there so I walked as far as the train station because there are usually taxis there. None there either so I ended up walking to the hospital despite nearly slipping on icy footpaths. I was seen by the triage nurse after about half an hour and everything beyond that was completely different to when I was diagnosed. My ketones had gone above 2.0 at that stage, making it to above 4 during my time in the hospital. I had blood taken and a tube stuck in my arm. A few hours later I was hooked up to a drip in the hall outside the triage and a change of shift happened and the nurse on the next shift removed the drip. I wasn't put on any trolley or moved to any treatment area. I didn't have my long acting insulin with me so I asked the nurse for some when I was due to take it. She said she'd get me some but she never did. At one stage during the night I said I wanted to go home to take my long acting insulin but another nurse told me there were only two people ahead of me in the queue for a doctor so I decided to wait. This was approximately 2am Sunday morning. I was sent back out to the main waiting area beside reception. This was when my ketones tested above 4. I got a gluten free sandwich to eat from one of the kitchen staff so that I could take insulin as I couldn't remember how long it had been since I took any at that stage. As I was eating I was called back in by another nurse to get further blood tests done. Then sent back out to the waiting area. 4am, about fourteen hours after arriving at A&E, I was finally called by a doctor. She took me to a treatment room only to tell me wait outside in the hall. She got me to give her a urine sample and asked me a few questions about me, my flu and my diabetes.
After that she took me back through A&E to the hall outside triage. Walking through A&E was like a war zone with all the bodies on trollies in the halls waiting for treatment, full treatment areas and not enough staff to cope with demand. I was put on another drip outside triage. I had to contain my annoyance and irritation at this stage because I could see the pressure the staff were under. The doctor came back to me a couple of times and the last time she came back with a diagnosis of dehydration due to flu. I don't know what the blood tests showed up but she also gave me a prescription for antihistamines and told me I could go home. So, basically, my ketones were high because of dehydration and the fact that I couldn't eat for a couple of days due to flu. It wasn't DKA (diabetic ketoacidosis) that I suspected it might be. I ended up walking home again at 7am Sunday morning after approximately seventeen hours in A&E.
Compared to when I was diagnosed with diabetes four years ago, it was a terrible and depressing experience. It was so bad in there that there was another man sitting in the hall outside triage waiting to be hooked up to IV antibiotics telling the nurse that he still wanted to go home despite the fact that he was coughing up blood. I think they wanted to send him to a bed in a ward because of his medical history and I hope he got treated properly after I left.
I don't want to get too political but the Irish government, department of health and health service executive should be ashamed of themselves for the way they've let the public health system deteriorate. We have a two tier system where those who can afford to go private get the best of treatment as soon as possible while those who can't are herded like cattle into something resembling a war zone. The nurses and doctors in the public hospitals do a great job considering how they are understaffed, under resourced and hospitals are mismanaged. I always credited the facilities and staff at my local hospital and was in disbelief when I heard stories at how bad things have gotten. I certainly believe it now but not enough credit goes to the staff in there for what they have to cope with.
I finally saw the endocrinologist after two cancelled appointments and a postponement. My first time seeing an endocrinologist even though I was diagnosed with diabetes at the end of 2018. I was in the hospital an hour. I got weighed in the waiting area at the outpatients by a nurse - 82kg with shoes on and stuff in my pockets. When I eventually got called by the endo the whole thing felt rushed and going through the motions. I had questions I wanted to ask and have a proper discussion about my diabetes but I never got a chance because the whole thing was so rushed I never thought of it. It's nothing like the care I get from my diabetes nurse and she has multiple patients as well. He looked at my notes, asked me a few typical questions, took my blood pressure, examined my tummy where I do most injections and checked my feet. He said my HbA1c was in the sixties when I asked him about my blood tests but didn't tell me much else apart from saying my thyroid reading was ok when he saw I had overactive thyroid in my teens on my record. Overall I found it to be a disappointing experience. He cancelled on me twice and postponed the appointment that ended up taking only about ten minutes. For perspective, I was in with a rheumatologist during covid restrictions and I had a more thorough examination and a good conversation about possible issues even though he found no conditions that he would specialise in from his examination of me. So I don't get why a 10 minute going through the motions that was going to be rushed anyway had to be cancelled! Just a note that in Ireland we do mmol/mol and not % for HbA1c, for anyone in % land.
On a different note, I checked myself a while after a junk food supper (always gluten free) and my meter said 7.6mmol/l. My sensor said 7.1 and steady, not rising or falling. The reason I checked again after eating was because I expected to need an insulin top up because of what I ate. But there was no point in topping up and risking a low with those readings. When I'm testing before taking my long acting insulin it might still be high as the supper time insulin wears off. But I probably won't top up because the long acting should bring it down a bit overnight. I find that if I top up too close to my long acting, only the fast acting will be effective so my reading might not come down as much sometimes. That's my own personal experience anyway.
My prescription only allows me 2 sensors per month but each one lasts 2 weeks, which covers the whole of February but not every ...
