A Diabetic rant - page 3

by veggie530

11,702 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


  1. 1
    I think that what I would have done personally is ...

    (1) Check the B/S level prior to administering any insulin.
    (2) Once I saw the B/S level was 56 I would give OJ and rechecked the B/S.
    (3) Once the B/S was in the acceptable range I would then contact the MD and let them know of my plan to give the Lantus as ordered and continue to monitor the B/S periodically throughout the night.

    My younger brother has IDDM since he was 11 and we have learned over the years (and many hospitalizations) that missing your dose of Lantus only ends up causing more problems then it ever solves.

    !Chris
    merlee likes this.
  2. 0
    And this is why I did my own diabetic management the one time I was admitted for surgery. Even with a morphine PCA I had more confidence in myself than my nurses. Sad, but true. It was suggested I could leave my pump at home and manage with shots. I just blinked and said "if it was that easy, I wouldn't be on the pump to begin with...." It's just as well because neither of my nurses knew anything about insulin pumps.

    Diabetes management education is sadly lacking. I work in oncology and we don't even treat hyper in the steroid induced diabetics until they hit 200. I wish the docs could walk around with their BS that high for a day. I bet they would lower the threshold. It boggled my mind during my med surg rotation that none of the pts got post prandial BS done. How can you know if the insulin was sufficient if you don't check that? It drove me nuts.

    So yeah....I feel your pain, OP!
  3. 0
    too tight a control has had some less than stellar consequences, from what i have read. Inre: post prandial BS, YES. It has been years that it has been known that many type II go undx, d/t compensation in FBS but obvious in post prandial, and the neuropathy that can come with diabetes can occur in this time period, can be, in fact the presenting complaint for type IIs. Need a GTT of at least 3 hours, or longer, with insulin draws, to get the "picture"''. What we really need is some one to invent a way to check blood sugars without "sticking" someone, over and over again. I have seen persons whose fingers were black and blue, ALL of them.
    Quote from ShantheRN
    And this is why I did my own diabetic management the one time I was admitted for surgery. Even with a morphine PCA I had more confidence in myself than my nurses. Sad, but true. It was suggested I could leave my pump at home and manage with shots. I just blinked and said "if it was that easy, I wouldn't be on the pump to begin with...." It's just as well because neither of my nurses knew anything about insulin pumps.

    Diabetes management education is sadly lacking. I work in oncology and we don't even treat hyper in the steroid induced diabetics until they hit 200. I wish the docs could walk around with their BS that high for a day. I bet they would lower the threshold. It boggled my mind during my med surg rotation that none of the pts got post prandial BS done. How can you know if the insulin was sufficient if you don't check that? It drove me nuts.

    So yeah....I feel your pain, OP!
  4. 0
    I am not diabetic, but this is just a case of not really knowing your drugs. If a person has a low BS, you can bring it up in 15 minutes with a snack/juice/whatever. You can still give lantus, because it has no peak, and the sugar will be up before it has much effect anyways. I agree with you, that is frustrating. Especially with some of the brittle diabetics and such.
  5. 0
    I would probably do what cjcsoon2brn said...I'm not giving any insulin until I know the BS is stable. There could be myriad reasons why the pt dropped. Sure it could be something as simple as pt didn't eat much with his dinner insulin, or something more complicated could be going in in the body.

    Then, ShantheRN said she (he? - dont want to assume) felt more comfortable managing insulin herself. That is great! I love when pts know what they should do/get, they definitely know better than we do (the pts that are with it, of course - I work in psych, LOL) because BS control is such an individualized thing. I will work to get an order that is reflective that the pt can have some control in getting their insulin the way THEY are used to. If I'm not sure what to do in certain cases, I always ask an AxO pt, what do you normally do in situations like this? And then call the doc of course to cover myself.

    I do agree that there was something missing in the OPs scenario, no follow-through after holding the lantus being the big thing.

    But on the broader idea of nurses not knowing anything about DM/insulin, I just want to throw this out there - it is easy to point fingers and criticize each other for a lack of knowledge, but if we are all being honest there is just no way we can know exactly what any given pt is going to need exactly for their insulin control. My goodness, the endocine system is so fragile in many ways, and there are millions of things that can affect it. Heck, it can take endocrinologists months and months just to get a pt on the regimen that is right for THEM. And the best way to manage BS levels in an inpatient setting is the subject of scores of research trials, scholarly articles, etc., & I'm not sure even experts agree on the best approach.

    This isn't an excuse for not learning more, and educating ourselves further. But it does underscore the importance of 1) obtaining accurate med recs/histories ON ADMISSION, and getting the correct orders for pts to continue their regimen during their admission. Otherwise the docs (hospitalists, psych docs - in my case) just order whatever sounds right, and sometimes pts are afraid to speak up about not getting the right things.
  6. 1
    having my insulin pump drives the clinicians CRAZY in the hospital!!! When I delivered my twins they sent an endo in the room (not my regular provider) and he flat out asked me if I needed help and I refused it and he left - guess he figured I knew what I was doing. Last summer I had my gallbladder removed and every nurse on the floor had to come in and see my pump and ask me questions - I was happy to oblige, but had to laugh when they kept trying to tell me how many units I needed based on "sliding scale". I take my own BG meter when I have to go and I really don't pay attention to their "sliding scale".
    SHGR likes this.
  7. 1
    Great post OP! Can I smell a future diabetic educator?
    cjcsoon2brn likes this.
  8. 0
    I have been type 1 since 2001 and have been on a pump since 2003. What most docs and nurses know about diabetes is scary. I started on a continuous glucose monitoring system 9 months ago. I wear a sensor/transmitter in my abdomen. I check a FSBS q 12 hours. The system transmits a BG q 5 minutes to a receiver so I know what my BG is at all times. It even has arrows to tell me if I'm trending up or down. It alarms if I'm below 70 or over 200. Most people have never seen one or heard of one before and those who have don't have a clue how it works.

    I was in the ER for a migraine a few months ago. I went in w a BG of 225. They did a FSBG and wanted to do SSIC. I told them I had a pump and a CGMS, that I was trending down, and that if I was getting fluids I would be hypo in about an hour and a half. The doc mumbled about "non compliance" ordered pain meds, fluids, etc. which were administered. In my pain fog, I forgot my glucose tabs. 30 minutes after my IV bolus finished my sensor beeped that I was below 70. I called the nurse, told her I was going hypo, she argued w me that my BG was high an hour ago, etc. By the time she got the glucometer, I was 53, sweating and headachy. Needless to say, the treated my hypo, and I was able to have a teaching moment w an ER doc, a nurse, and an ER tech about IV fluids effects on BG, the pump, and CGMS.

    The bottom line for me is that I always listen to my patients symptoms and if they tell me they are feeling a certain way, I listen. I also think that SSIC often do more harm then good. Proper basal insulins/meds, carb counting w meals, and SSIC for the rare time for clean up would solve a lot of problems. IMHO.
  9. 1
    Quote from morte
    too tight a control has had some less than stellar consequences, from what i have read. Inre: post prandial BS, YES. It has been years that it has been known that many type II go undx, d/t compensation in FBS but obvious in post prandial, and the neuropathy that can come with diabetes can occur in this time period, can be, in fact the presenting complaint for type IIs. Need a GTT of at least 3 hours, or longer, with insulin draws, to get the "picture"''. What we really need is some one to invent a way to check blood sugars without "sticking" someone, over and over again. I have seen persons whose fingers were black and blue, ALL of them.

    The technology is here, but not used often due to cost. Some type 1's (and maybe some type 2's that are insulin dependent) use continuous glucose sensors that get a bg reading every few minutes. It would be great if all patients in the hospital that are insulin-dependent could use these, and we'd have much better control because we could see what was happening and the trending, including if the bg is headed up or down.

    Another issue is that the lancets used in hospitals are huge and basically slice the fingertip open instead of a smaller puncture. It's brutal on their fingers, and unnecessary, imho.
    morte likes this.
  10. 0
    VBRNJD99, How frustrating that must have been for you!! I too have an insulin pump, although when in the hospital (which thankfully, isn't very often) the nurses and docs usually listen and let me manage my BS/pump, they usually concede that in order to have an insulin pump, one must be very knowledgeable about the management of their sugars etc...and frequently I am able to educate them. So sorry you had a bad experience in the ED!


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