A Diabetic rant - page 4

by veggie530 12,529 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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    In my hospital, most of the nurses are well aware of how Lantus works. (The newer nurses not so much~ but they are learning.) That being said, our protocol is that we must call the doctor for any glucose level below 60, then it is up to the doctor to say "hold the lantus," or "give a reduced dose." We don't hold it unless the doctor tells us to, because that is against the rules of our practise. We have a large poplulation of non-compliant diabetics, and many times it becomes "trial and error" for us, just to get their glucose levels regulated.
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    I got in SO many discussions with instructors about D. I have a son T1 (dx @ 2; 6 years ago) I am T2; dx 2 years ago, I had Gest. D while pregnant with both children. I, too, am amazed at how little is taught/known in general med profession. My 8 year old knows more about treating his D than most. I had a pt in clinical (I am a new grad) that hx had her T1 on one sheet, T2 on another???????? (uncontrolled either way) When I would ask questions in clinical, no one could answer them. I have strict instructions on my son's medical ID bracelet as to his care if he needs emergency care and I am not there.
    I just started at a LTC/Rehab and there are several pt that are on FSBS 2x/week with SS (how in the heck does that make sense in ANY world).
    I am seriously thinking of eventually becoming a CDE for hosp staff/nursing. It is truly amazing the lack of knowledge. I always asked when presented with a scenario/question in school when the situation said "pt is diabetic" whether it was T1 or T2 and was ALWAYS told-it didn't matter. Being a T2, my treatment would be VERY different that my T1 son. OY!
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    It is my hospital's policy that anyone who has an insulin pump is automatically referred to the endocrine service, which has an endocrine NP who takes a look at the pump and provides staff education as needed. If the patient is alert and oriented they stay on the pump, if not then they make a decision on what kind of glucose control is most appropriate (SS, insulin gtt, etc.).

    Glucose control for long-time diabetics is often pretty complicated in the hospital (at least where I work). Obviously the patient is sick and under increased stress, their eating habits change, their activity levels change. All of these factors will affect the patient's sugar, and what works at home may not work here. However I am in agreement that the patient needs to be as involved in the management of their blood sugars as possible. After all, who is going to be doing it after discharge?
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    When my husband, who is type 1 brittle, is hospitalized, I'm right there with him at his bedside 24/7 with his meter and his Apidra. I tell the nurse right up front what I'm giving him and when, as a courtesy -- I want her to know what he has on board while he's in her care -- but we do not leave his treatment to the floor nurses under any circumstances. Not to mention they are only allowed to give sliding scale ACHS, when I can give it to him whenever he wants/needs it! I've received very little resistance from it; just a few sour looks sometimes (this was when I was a student nurse -- now that I'm an RN we haven't had this problem much but we shall see).
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    this is frustrating to me as well. Some people think all insulin is alike. It speaks to how we need to constantly be educating ourselves on medications.
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    I am obviously one of the ignorant, but, a blood sugar of 500 will throw you out of sorts for a day or two-even if it is corrected quickly, but a glucose of 20-30 can throw you into the morgue- for a lot longe than a day or two. I know Lantus is long acting basilar insulin, but if the dose is so far out of the needed range for the patients needs, it seems like adjusting the dose at 56 would be in order. It would depend on if the patient was depending on short acting insulins to cover meals or if the lantus was the only source of this dangerously low glucose. Were they NPO for the day? Are they NPO for something tomorow? Lantus meets your insulin needs based on a pre-determined caloric intake and energy demands. If thise have chaanged- why shouldn't the dose if Lantus change? Snacks sound like a great idea, but sugar/juice is often the only option at hs in the hospital. I can't tell you how many times I've gotten into my own lunch to provide something other than simple carbs/sugar for my patients hypoglycemia snack. Giving a short burst of sugar dosen't fix the problem, but just moves the hypoglycemic crisis to 3am when it is difficult to assess the patients status. Hypoglycemic coma or sleeping quietly?- I have to wake them up and/or check thier sugar to know. I am fine with giving Lantus to a patient with a low sugar if I have come protien/fat/complex carb to give that Lantus something to work on. What I'm seeing is the dose of Lantus has already proven itself to be excessive in reducing the patients blood glucose. Why not make the adjustment in the dose when this is discovered rather than try to play catch up with hypoglycemia when you could be 10 hours from the next meal. I'm willing to admit it if I'm wrong, but I rather err on the side of hyperglycemic but "not dead" if there is a question.
    canoehead likes this.
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    I keep seeing phrases like the nurse's tx, or the nurse's sliding scale or the nurse decided to give X amount.. I'm sorry but we don't write the orders or the sliding scales. The PCP does that, we just follow it, watch the pts trends and hope the PCP will listen to us when the coverage is not enough or too much.
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    Sun0408 is correct.

    As a long time type 1, I'm always amazed at how little MDs know about diabetes and the medications that treat it. When I was in the hospital delivering my son I was surprised that the MDs and nurses acted like I was clueless about dosing my own insulin and disregarded my recommendations. This was after 30 years of successfully managing my diabetes and having an extremely health pregnancy (with a 5.1 hemoglobin A1c).

    With diabetes knowledge is power. This lack of knowledge is killing diabetics and causing DM complications. And best of all, healthcare providers then blame the patients for non-compliance.
    Tatinha likes this.
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    Quote from delphine22
    When my husband, who is type 1 brittle, is hospitalized, I'm right there with him at his bedside 24/7 with his meter and his Apidra. I tell the nurse right up front what I'm giving him and when, as a courtesy -- I want her to know what he has on board while he's in her care -- but we do not leave his treatment to the floor nurses under any circumstances. Not to mention they are only allowed to give sliding scale ACHS, when I can give it to him whenever he wants/needs it! I've received very little resistance from it; just a few sour looks sometimes (this was when I was a student nurse -- now that I'm an RN we haven't had this problem much but we shall see).
    I think this is a great way to manage. I hate trusting patients that are sick and possibly groggy to make judgement calls on insulin, but hospital management is not as personalized and effective as what people work out at home. If you were in hospital I'd have to write notes about noncompliance and educating re plan of care, but I'd be cheering on the inside.
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    lantus meets your insulin needs based on a pre-determined caloric intake and energy demands.
    that is not a basal rate; that is not what lantus is for. you are correct that lantus is for basal requirements not to include carbs and/or exercise-for a t1 anyway. the short-acting is for that. to me a bs of 56 (20-yes) is not that critical for my son, and if he does go that low, we do not suspend his pump to stop the basal rate that he is getting. we treat the low and go on. every diabetic is different, so what works for him, may not work for another.


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