Sliding Scales

All is good here. I am settling into hospital life and routine and Friday when my induction is scheduled is fast approaching! I'm getting used to the daily routine of monitoring - see above!

I mentioned in my last post that I went onto a sliding scale whilst I was being given steroid injections to help develop the baby's lungs, apparently this is because the steroid injections can send your blood sugars all over the place. I came off my pump on Tuesday afternoon before my first steroid injection and stayed on the sliding scale until Thursday afternoon after my final injection. At first I was just on insulin then they added a drip that was a mix of saline, potassium and glucose.

Basically how it works is they/you measure your BG hourly and then the slide is adjusted depending on the result. I was on rates between 1-5. One when my blood sugar was at it's lowest (i.e. normal levels) and five when it was at its highest.  

Each time I ate my BGs rocketed and I was on a scale of 5, with it taking a few hours for my BG to come down. After breakfast one day it hit 17mmol/l and I kept questioning them about the sliding scale and how it was obvious that every time I ate I needed more insulin and wasn't being given it quick enough. (For example I could eat at 1.10pm but the sliding scale wouldn't be adjusted till 2pm). Some of the doctors/midwives were saying it was fine it was the steroids etc. but I knew there just wasn't enough insulin being given to me to cope with eating. I spoke with my diabetes nurse and she said that sometimes people gave an additional bolus when they ate but seeing as though I wouldn't be on the scale for long it was probably okay, we would also have to work out how much bolus to give and that could be difficult.

I was getting quite stressed and annoyed about it, after all I had been putting all my effort into not getting BGS of 17 mmol/l and here I was in hospital running higher than I had in weeks. Also apparently it is protocol to give the glucose/potassium/saline mix - although I have since found out that this really should only be given if you are not eating and I was eating! Clearly some confusion along the way...

It was Thursday morning when I spoke my diabetes nurse again and she told me that one of my diabetes doctor (I have two - one more focused on the baby side, one more focused on the diabetes side) had said she never wanted me to go on the sliding scale, she had wanted me to stay on my pump. It was the other doctor who said I should be on the sliding scale. I came off the sliding scale that afternoon based on this and guess what by evening time my BGs were down to normal and an hour after my evening meal I was 7.6 mmol/l. 

So now I am anti the sliding scale! I have said that when I get induced on Friday there is no way I am automatically going onto the sliding scale. I would like to be given the opportunity to self manage for as long as possible. If I get to the point where I can't eat, start vomiting or am completely our of it and can't manage then I will give in and go on the sliding scale but until then it is me and my pump! I have been told my diabetes doctor will fully support me on this. 


Tomorrow I have an appointment with the obs so will be bring this up with him and I will be flagging up the fact the sliding scale was useless. We may have a fight on our hands!