A Diabetic rant - page 2

by veggie530 12,141 Views | 43 Comments

Hey guys. I've been a type 1 diabetic for fifteen years now and I'm set to graduate the program in May 2013 -- I clarify that because I don't want anyone to think I'm already working or think that I'm trying to be a... Read More


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    Glycemic control should be a concern for all nurses. Diabetes and blood sugar regulation is a 24/7 issue.
    Sadly, there is not enough critical thinking going on. The issue becomes...how should this PARTICULAR blood sugar reading be handled.

    I think the answer is an evidenced -based protocol that is policy.
    barbyann likes this.
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    I hope this attachment works. I took a diabetic resource nurse course last year and for my project, I made cards regarding types of insulin and their actions. They fit in a plastic sleeve to wear with your name tag. I refer to mine a lot! I gave them to all of the nurses in the ED. It has been most useful! If this attachment works, you are more than welcome to use them.

    There are good resources out there that can be made into pocket cards for quick reference.
    Name:  Diabetic chart 001.jpg
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Size:  437.4 KB
    Last edit by Dixielee on Jul 3, '12 : Reason: image
    Race Mom, Miss Molly, SwansonRN, and 9 others like this.
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    At my facility the lantus shows up on the MAR with a message that says do not hold for NPO or low blood sugar. Most docs will just decrease the lantus if the pt tends to drop at the same time a few days in a row. So maybe its just where you work that people don't understand lantus.
    CoffeeGeekRN, hecallsmeDuchess, SHGR, and 1 other like this.
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    Quote from veggie530
    Hey guys.

    I've been a type 1 diabetic for fifteen years now and I'm set to graduate the program in May 2013 -- I clarify that because I don't want anyone to think I'm already working or think that I'm trying to be a know-it-all, but this drives me nuts.

    At a few facilities I've been to I've noticed an alarming trend regarding Lantus. Now, I'm sensitive to this because I actually take Lantus and know how it works, but a lot of med-surge nurses don't seem to know -- and equally alarming is SOME DOCTOR'S DON'T, EITHER!

    A patient had a blood glucose of 56 (low, not that terrible, to be honest... an OJ will fix it just fine) at bedtime check and because of that the nurse called the doctor and with held the lantus!

    Now, lantus is a baseline insulin. It lasts ~24 hours and keeps the blood sugar at normal operating level (65-110 or thereabout) for that time period. If you with hold lantus there is no insulin left in the body (for practical purposes) to keep glucose normal!

    Needless to say, patient woke up with a glucose of 500+ because they had no lantus on board. Morning shift nurse (more experienced) corrected the error by calling doctor again and administering the lantus.

    Please, please, please be a patient advocate. If I were in the hospital you couldn't pry my insulin from my cold dead fingers because I don't trust that the knowledge is out there on exactly how diabetes and the meds work. If you're not diabetic and your glucose has never hit 500, I can't explain to you how crappy you feel for a long time even after it returns to normal.

    /rant
    So she held a standing dose of insulin and didn't recheck the sugars at all overnight?

    This is precisely why I would ONLY speak with the Endocrine team about Diabetic patients when I worked in the hospital. Fortunately, at the hospital I worked at, Endocrine was automatically consulted upon admission of a patient with known diabetes (I only ever saw them if they had something neurological or neurosurgical going on)... I didn't take care of a lot of Diabetic patients in my time there, but I had a few who Neurology or Neurosurgery Docs would have screwed up royally if it had been up to them.
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    Quote from Dixielee
    I made cards regarding types of insulin and their actions. They fit in a plastic sleeve to wear with your name tag. I refer to mine a lot! I gave them to all of the nurses in the ED. It has been most useful! If this attachment works, you are more than welcome to use them.
    What a great idea!! I love the idea of having the onset, peak, duration chart so available!
    Dixielee likes this.
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    @DixieLee, thanks, I printed out your chart.

    @OP, I also think it depends on how many units of Lantus the pt is supposed to be getting. Usually, if a pt is 56 I'll give some carbs, recheck the sugar then call the doc if it is still low (again depending on how many units ordered) so they can decrease it. But 56-500, someone dropped the ball big time for that to happen. When people run low, even once on my shift, I keep a close eye on their levels to make sure I don't have any surprises, and when I leave I pass on the surveillance to the next shift.
    grpman, Dixielee, and Blufea like this.
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    I'm a type 1 diabetic and was once hospitalized. During an overnight, my blood sugar was high and the nurse just randomly decided to give myself 4 units of insulin, despite the fact that wasn't my correction factor and it had actually been an hour since they tested me! I woke up high, but still the nurses were not going to give me any insulin because no one had told them to. It was like being 300 mg/dl was A-OK (note: it isn't!). I was so ******. The doctor who finally came by in the morning apologized, but OMG. I just don't understand how people can become nurses without at least learning the basics of how these medications work!
    Patti_RN likes this.
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    I've seen the same things happen and it's really appalling.

    Two of our kids have type 1 diabetes, and younger one dx at 18 mos, so I've been managing her diabetes for 8 years now. You wouldn't believe some of the things we've had medical professionals tell us. When my eldest was dx at age 22, his BG was 500 on admission with ketones, and the positive hx of family type 1, no risk factors for type 2, and still several physicians told him that "this may be able to be controlled with diet and exercise."

    The discharging dr reluctantly gave us a prescription for novolog because I wouldn't leave the hospital without it, but wrote up a sliding scale, and NO basal insulin, and told us to get an appointment with an endo in a few days. Thank God I knew better, and was up all night checking him every two hours, giving injections of novolog (trying to be his insulin pump, lol) and able to keep him out of DKA, and took him to another ER the next day, because--surprise-none of the area endos could manage to fit him in. The experience at the next ER wasn't much better, but we did manage to finally see an endo and get appropriate medical care. The ER physician at the second hospital admonished me for insisting on an endo consult, and not allowing him to just prescribe the insulin because, and I'm quoting here because I'll never forget it...."diabetes isn't rocket science."

    Last year I was doing an RN refresher course (stayed home for over a decade), and saw the same thing you described. One of the floor RNs held the basal insulin and then was surprised at how much the patient's bg increased over the course of the day.
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    Quote from veggie530

    Needless to say, patient woke up with a glucose of 500+ because they had no lantus on board. Morning shift nurse (more experienced) corrected the error by calling doctor again and administering the lantus.
    No checks during the night?
    merlee and KimberlyRN89 like this.
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    That's terrible.


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