My mom doesn’t take any diabetes medicine. She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption. A few months ago, she had to be hospitalized for what she calls a “minor procedure.” The procedure went fine, but not the food. The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar packets on tray). “If I ate that, my blood sugars would have gone through the roof!” she told me. She drank the tea, and called my dad, who arrived shortly with chopped salad, roasted peppers, and meat loaf. This week’s post is about hospital food, if you can call it that. You are not going to believe what it’s like to order meals for hospitalized patients.
Let’s imagine, for example, a diabetic guy in the intensive care unit. His blood sugars have been completely out of control, up and down, up and down. He is recovering slowly from a very serious pneumonia, and is only now beginning to eat again. The nurse asks if I’d like to order an 1800 kcal ADA diet, which I do not.
An “1800 kcal ADA” diet means 1800 calories total each day, in accordance with the recommendations of the American Diabetic Association. Their recommended diet is loaded (and I am not exaggerating here) with processed carbohydrate items guaranteed to make it nearly impossible to control one’s blood sugar. No thanks.
Instead of an 1800 kcal ADA diet, I order a “low-glycemic diet,” which is not actually one of the approved options in the hospital. I know I’m setting myself up, but there are no other options I can order in good faith. Real food? High fiber and protein? Low-processed-carb? I wish. The kitchen sends fake scrambled eggs (beaters) and a large blueberry muffin. I kid you not. This is what Sodexo, which supplies the hospital food where I work, actually sent for my diabetic patient a few weeks ago.
It should surprise no one that his blood sugars spike into the 400’s after lunch. I ask the nurses if we can just get the patient a hard-boiled egg. No, we cannot. The hospital does not actually have eggs. Just beaters.
Patients aren’t the only people who eat in hospitals. A few years ago I decided to get a cup of coffee in the hospital cafeteria. I looked for the milk, but there was none. There were only single-sized servings of flavored liquid non-dairy coffee whiteners. I don’t use those; they are not food. I asked for milk and was told I would have to purchase it.
Patients who are less ill than my intensive care unit patient are permitted to choose their own daily meals. They are provided with printouts, or “menus,” as the Dietary Department calls them, which are simply lists of all the items available for consumption in the hospital. Patients choose what they like, and a version is prepared that attempts to meet their dietary restrictions.
A common scenario for me, as a physician, is one in which I work to control a patient’s blood sugars in an attempt to heal a leg infection and avoid an amputation. High blood sugars interfere with healing because they prevent white blood cells from working correctly. Now, imagine me walking into a patient’s room and seeing that patient eating a bowl of Raisin Bran (one of the highest sugar-containing cereals) on a tray that also contains a glass of orange juice, tea with sugar packets, and 2 slices of toast with margarine. I know these options will spike my patient’s blood sugars and make it nearly impossible for me to get them under control. I am wondering why those options were on my patient’s “menu” in the first place.
If it weren’t so serious, it would be comical. Like putting a humidifier and a de-humidifier in the same room, and letting them duke it out (thank you, comedian Steven Wright!). I don’t want to duke it out. I want to be able to ask for, and receive, the tools I need to do my job successfully. Assigned the task of healing patients and controlling their blood sugars, I expect to be given the tools to do so. Different kinds of professionals use different kinds of tools. My first tool is food.