"Lack of diabetes knowledge from staff"

I was admitted into a ward in A&E almost immediately after arriving and reporting symptoms of diabetic ketoacidosis, I had called nhs 24 for some advice beforehand as had been fortunate enough not to experience this up until now, despite being diabetic for almost 16 years. The staff in A&E were excellent and really set my mind at ease and I felt very safe there during what was a very scary experience for me.

After around an hour and a half, I was moved to ARU 4. The standard of care here was nowhere near on the same level. Although my dietary requirements were asked for, this was not recorded on my door as it had been for other patients, leading to me having dry toast as the only option when I was able to eat again. Whilst some of the staff on this ward were great, it often took a long time to get hold of a member of staff when required, such as pausing my insulin, fluids and glucose to allow me to go to the bathroom.

I was also advised in A&E that my fluid output would be measured, this did not happen at all after being moved ward. Several nurses also didn’t turn the lights off or close the door to my room as I had requested during the night after they’d been in to check my obs, despite me requesting this. This left me feeling quite exposed as people could see into my room when going past in the corridor, I felt I had no privacy and could also hear what other patients were being told on the ward due to this. Due to the lights being left on, I also really struggled to sleep.

My main concerns are several things that happened the morning of discharge. I was advised around 7.30am by the doctor on the ward that I would be allowed home before lunch if I was able to put a new insulin pump on and eat breakfast with no issues.

An unidentified tablet was brought round by my nurse. I questioned what this was and why it had been prescribed as it was not a medication I take or had been informed about. The nurse was able to tell me the name of the medication, but not what it was for, and took this away when I wanted to know what it was which I found worrying. I never received clarification on why this had been prescribed or what for.

Breakfast was brought round just prior to 9am and I heard my nurse being advised that I could come off the ketoacidosis pathway prior to this. I had rang for the nurse when breakfast was brought round and it took 25 minutes to get a response.

At this stage, I was disconnected from fluids and insulin but the IV was left in my arm. I explained to the nurse that this would need to be removed or I would need assistance putting my insulin pump on. I was told the nurse would return shortly to do this. Ten minutes later, I had a hypo which I immediately rang staff to inform them about and mentioned that I also was still without insulin. I was told my nurse would be informed. Five minutes following this, the same member of staff had come back to check on me and my sugars.

Despite receiving no hypo treatment, my sugars had risen due to having no insulin onboard. I again raised that I was concerned about how quickly my sugars were rising, especially considering that I had been admitted for DKA and this had taken all night to get rid of. I was again told that my nurse would be through soon. My sugars continued to rise, and after 45 minutes I was in tears and on the verge of a panic attack due to my anxiety over this not being taken seriously.

Only at this point, did my nurse see me and remove the IV to allow me to put a new insulin pump on. I explained what had happened and why I was worried, but they did not seem concerned regarding this and did not seem to have an understanding about how dangerous it can be for a type one diabetic to be left without insulin for a long period of time.

Due to the time without insulin, despite me trying multiple times to advocate for my health needs, my sugars were slightly elevated for the next few hours following insertion of the new pump, including when I was discharged.

Despite being told I could go following having a new pump applied and eating something, it took a further hour for me to be discharged, despite myself and my mum overhearing another nurse on the ward say it was fine for me to leave when we initially asked.

My nurse didn’t check my bloods, ketones or confirm that my insulin pump was definitely working before leaving and had to ask me whether I was waiting on any prescription when this was information I believe they should have been aware of.

It all felt very disorganised and did not fill me with confidence that the ward could meet my care as someone with a chronic condition. I believe further training on type 1 diabetes and ketoacidosis should be provided to staff on this ward, or diabetic patients experiencing DKA should be admitted to a specialist ward from the get go so that their needs are met.