A Diabetic rant

Specialties Endocrine

Published

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

Specializes in Trauma Surgical ICU.

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.

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.

Specializes in ER.
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.

Specializes in orthopedic/trauma, Informatics, diabetes.

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.

I'm type one diabetic for 16 years...since I was 8 ... in would have give a very small glass of o.j. I don't know about other ppl but I respond very quickly to drinking o.j. then monitored th bg level till its in the 80 to 120 range then administered the insulin. ...even my pump advises me not to bolus until my sugar is in a normal range

AMEN!!!!!!!!!!!!

The bottom line is that if a patient has been dealing with a chronic disease on their own--no matter what degree you hold--the patient KNOWS THEIR BODY BETTER THAN YOU AS A NURSE...LISTEN TO THEM!

Geez. The stigma around Type 1 is sickening. The comments I recieve that people "assume" or hear in the media. Next time someone tells me I can't eat a cupcake I will scream...

/rant.

Hey, everyone...

I know this original post was posted in July, but just saw it.

After 43 years of T1DM, I kinda know what I'm doing. Additionally, I'm a Certified Diabetes Educator (I did not know about the oral meds very well before training for the CDE).

There are MANY PCPs and other docs who are clueless. As someone said, it is up to US to advocate for our patients. However, when the doc just won't listen, we need to get our patients to ask specific questions. I give my patients the questions to ask and the answers they should hear when it comes to meds. If they don't hear the right ones, they should see an endocrinologist. I have also seen some 'internists' give totally wrong info. go figure.

"My fasting/pre meal sugars are all just fine, but my A1c is 8.1. Well, now. There are great clues here to narrow the field of optimal medications. Maybe an alpha glucosidase inhibitor would be a good option? Or, maybe, prandin or starlix? You are so right that knowing about the diabetes meds can help our people so much more. EVERY doc should have to attend DSME/T (Diabetes Self-Management Training) before treating people. 8 hours could help everyone so much more.

OFF my soapbox now! Thank you for your post.

Joan

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