Wednesday, April 10, 2013

Rizzo's Ramblings...My adventures in Redneckistan

As promised, here is a look into my life in a small town filled with ignorant people. As some of you who read the blog know, my daughter was diagnosed a type 1 diabetic a few years ago. (If you are not familiar with that story, you can play catch up here.) Last Thursday I received a letter in the mail recalling her insulin pump. On Friday morning I called her doctor's office to let them know her pump had been recalled, and to request a prescription for syringes as well as the information needed to calculate and give her the correct does of insulin. Taking care of type 1 diabetes is detail oriented and involves quite a bit of math. I will try to explain it as best I can so that you can understand the story I am about to tell. When a diabetic (please keep in mind that I am referring to type 1. I have no experience with type 2, and it is a whole different ballgame) wakes up the first thing they have to do is check their blood sugar. Normal range varies for everyone, but for my daughter anything between 70 and 150 means she does not need any insulin. If she decides to eat, however, then she has to count the number of carbs she will be consuming and calculate how many units of insulin she will need to "cover" those carbs. Her carb to insulin ratio is 7 grams of carbohydrates to 1 unit of insulin. So, if my daughter were to eat 14 grams of carbs, then she would have to inject 2 units of insulin. That is, as long as her blood sugar was somewhere between 70 and 150. If, for some reason, her blood sugar is higher than 150, then she has to inject extra insulin to bring her blood sugar down to within the "normal" range. This is calculated by a sliding scale. All sliding scales are based on each individual. When a diabetic is on an insulin pump the doctor programs the pump with all this information and all the diabetic has to do is put in the number of carbs they will be consuming along with their blood sugar and the pump will calculate it all for them and give the correct amount of insulin. So, on Friday morning when I called the doctor for syringes, I also had to ask for a sliding scale. I called the doctor at 10AM. By 3PM I had not received a phone call back from the doctor, and the pharmacy had not received a prescription for syringes. I called the doctor's office back. I was assured that the message had been passed on to the nurse practitioner and that all would be taken care of before the end of the day. AT 4:57PM I still had not heard anything and so I called once again. This time I was on hold for a few minutes when a nurse (I have never spoken to before) came on the line and informed me that the nurse practitioner who was supposed to be taking care of this for me had went home for the weekend! Keep in mind that I had received a letter in the mail recalling my daughters insulin pump because it could, at any time, give her a dose of insulin that could cause serious injury or death. The nurse that I was speaking with saw the importance of getting my daughter off the pump and was happy to call in the syringes, but could not tell me what sliding scale to use because she was not familiar with my daughters case. I still had the sliding scale that we were given three years ago when my daughter was diagnosed and so the nurse and I agreed that anything would be better than risking keeping her on the pump. The sliding scale that I have is in increments of 60. So if my daughters sugar is between 150 and 210 she gets an extra unit of insulin on top of what she eats. If it is from 211 to 270 then she gets 2 units. This continues to increase by 60 with each added 60 being another 1 unit of insulin until she reaches 5 units. On Monday I kept my daughter home from school just to make sure that she was going to continue to do well on the shots. I also wanted to hear from the doctor's office to see if they were going to make any changes. I did receive a call from them, but it was only to ask me what scale I was using and to ask me when we would be getting the pump back. I didn't really understand that question because I am not the pump manufacturer and I do not repair them. Tuesday morning I went with my daughter to the school to explain to the school nurse what had happened and to give her the syringes and dosing information she would need to make sure that my daughter got the insulin required. At this point, the school nurse informed me that without written and signed doctors orders she could not allow my daughter to have insulin injections. This school nurse is well aware that my daughter is a diabetic. She has seen my daughter everyday at lunchtime and insists on helping her to program her pump even though my daughter is 14 and has been on a pump for 2 and a half years. This nurse is well aware that the only thing keeping my daughter alive is insulin. So, I told the nurse that I would not be able to leave my daughter at school knowing that they would not allow her to have insulin. I then asked if it would be an excused absence since the school was the one with holding my daughters medication. The nurse told me I would have to speak with the principal about that. So, I went to the principal and asked her if it would be an excused absence and the principal told me that I would need a doctor's excuse because I had failed to get the doctor to fax in the proper paperwork to the school in a timely fashion. SO, I took my daughter home and immediately called the doctor's office and requested that they fax in the orders to the school as well as doctor's excuses for Monday and Tuesday. Yesterday afternoon at 3:15PM the school nurse called me to say that the doctor's office had, in fact, faxed in the orders but that instead of writing out a detailed sliding scale they wrote 1 unit/60 >150. That means 1 unit for every 60 points greater than 150, which is the sliding scale that I had written out in detail for the nurse and given to her just that very same morning. The nurse informed me that she could not accept that from the doctor and until she got a detailed scale faxed into her office she could still not give my child her insulin. She then went on to say that if I chose not to send my daughter in to school on Wednesday (today) I would have to talk to the school principal about getting it excused. That is when I informed the school nurse that I really didn't care if the absence was excused or not. I really had no choice in the matter because if they were not going to allow her insulin then I was not going to allow her to attend. I made it clear to that nurse that as far as I was concerned she had a doctors order and with holding my daughters insulin, should I choose to send her, would be a crime.  THAT is what I have been dealing with the past few days! So, you will have to understand when I rant and rave about people's ignorance and having to live in Redneckistan.

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