Diabetic Pet Peeves

Specialties Endocrine

Published

I was responding to the forum on insulins and this popped into my head. A discussion on how to better care for a large and growing diabetic population.

Pet Peeve#1: People diagnosed with diabetes can eat sugar! or products made from sugar...cake, cookies, donuts, candy bars and chocolate. It all comes down to carb counting. All nurses should learn carb counting and insulin to carb ratios so they can better serve this population.

Pet Peeve #2: Type 1 and Type 2 are different. Although many type 2 diabetics require insulin...the action or reaction to it is different. Type 2 pts need to follow a diet regime that works with their antihyperglycemic meds. Type 1/ Type 2 on insulin can eat sugar products under the carb count guidelines and as long as there isn't excessive weight gain. Also know that exercise plays an important role in lowering blood glucose. Learn the differences so you can provide the appropriate care.

Pet Peeve #3: Although there is a large population of type 2 diabetic people, the population of type 1 diabetics and a latent onset is growing. Bone up on type 1.

Pet Peeve #4: No diabetic needs more than two insulins. Learn the onset and action of all insulins. Cater a program to work for your diabetic patient.

Pet Peeve #5: The brittle diabetics need DDAVP, not insulin.

Blood sugars can be controlled with the right program.

Pet Peeve#6: People with diabetes...DO WANT TO CONTROL THEIR BLOOD SUGARS. Contrary to popular belief...we do...it's a hard thing to do. We have it for life and sometimes...even with the best control...you still loose a limb, a retina detaches or you end up on dialysis. Oh well. But we can extend our lives as long as possible with good control.....70-120!

Can we get a Diabetic forum?

Shelly

Oh yes. Let's do...Maybe I can learn something..and maybe someone else will too. Are you da teach? I am ready!

Do you really want to?

Grannynurse:balloons:

We can also discuss the difference between DKA and HNKC.

DKA-diabetic ketoacidosis

HNKC-Hyperosmolar Nonketotic Coma Syndrome

I know HNKC as HHS

HHS usually occurs in older, obese individuals with Type 2, who may have dminished renal fuction, infections, urinary tract infection and sepsis are the most common prexipitating factors. Others may include inadequate adherence to one's insulin regimen and a new diagnosis of diabetes. It can also be triggered by an MI, stroke, pregnancy, surgery, acute pancreatitis and medications that have a hyperglycemic effect. It takes days, even weeks to fully develop. Patients do not generally show symptoms until glucose levels (600mg to over 1000mgs) become dangerously high. The S & S reflect dehydration, altered carbohydrate, lipid and protein metabolism. They inlude thirst, tachycardia, polyuria, fatigue, weight loss, reduced sskin elestacity, and blurred vision. Also an altered mental status. Serum and urine ketones are absent or in trace amounts. Untreated it can lead to coma and death.

DKA

Often seen in children and patients under 38 because they have Type 1. Tend to develop more rapidly, within 24 hours, accumulation of ketone bodies and they develop symptoms sooner after blood sugar level goes above 250mg. S & S are similar but because it includes metabolic acidosis, they tend to have nausea and vomiting, localized abdominal pain-due to K depletion and fruity bereath from ketones. Serium and urine ketones present.

Grannynurse:balloons:

Sorry to miss lead you, brittle diabetes is diabetes insipidus. No DDAVP for type 1 needed. I was bringing up miss leading information to stimulate the conversation. Whoops, forgive me.

I have never heard the term brittle diabetes for DI...it has always, in my tons of visits to endocrinologists and doctors and camps and seminars, been used to describe a type 1 diabetic who has blood sugars that swing easily and without apparent reason...or who is hard to control.

Interesting.

Cassi

Specializes in tele, stepdown/PCU, med/surg.

DKA folks who aren't treated can get life-threatening hyperkalemia...

Specializes in Oncology/Haemetology/HIV.

Brittle Diabetes is the term used for very unstable diabetes mellitus, in my parts of the Country.

Diabetes Insipidus is a very different animal.

Perhaps the OP could clarify?

Specializes in Gerontology.
I know HNKC as HHS

HHS usually occurs in older, obese individuals with Type 2, who may have dminished renal fuction, infections, urinary tract infection and sepsis are the most common prexipitating factors. Others may include inadequate adherence to one's insulin regimen and a new diagnosis of diabetes. It can also be triggered by an MI, stroke, pregnancy, surgery, acute pancreatitis and medications that have a hyperglycemic effect. It takes days, even weeks to fully develop. Patients do not generally show symptoms until glucose levels (600mg to over 1000mgs) become dangerously high. The S & S reflect dehydration, altered carbohydrate, lipid and protein metabolism. They inlude thirst, tachycardia, polyuria, fatigue, weight loss, reduced sskin elestacity, and blurred vision. Also an altered mental status. Serum and urine ketones are absent or in trace amounts. Untreated it can lead to coma and death.

DKA

Often seen in children and patients under 38 because they have Type 1. Tend to develop more rapidly, within 24 hours, accumulation of ketone bodies and they develop symptoms sooner after blood sugar level goes above 250mg. S & S are similar but because it includes metabolic acidosis, they tend to have nausea and vomiting, localized abdominal pain-due to K depletion and fruity bereath from ketones. Serium and urine ketones present.

Grannynurse:balloons:

PLEASE DO NOT FORGET SEVERE ABDOMINAL PAIN:o THIS PAIN WILL MAKE A PERSON :bluecry1: I AM TYPE 1 AND DKA IS NO FUN.

Specializes in Adolescent Psych, PICU.

I'm going to be listening in on this discussion as both a nursing student and someone who has had gest. diabetes myself (and I still have a lot of issues with my blood glucose levels) and both my parents are diabetic. My dads a1c has usually been ok (about a 6) but yesterday he got his results back and his a1c was a 10!!! We are trying to get him to go on the pump but he wont do it..."I don't want to wear it all the time".

My mother has diabetic neuropathy because she had diabetes for years apparently and didn't know it :( I see her in a wheelchair in a few years and it just kills me.

I am worried about getting diabetes myself, it seems everyone in my family has either type 1 or type 2 and no one is overweight, I can only imagine it must be genetic. I do workout a lot and am trying (but not hard enough) to lose about 15 pounds. It's just hard. Thanks for listening.

Specializes in Telemetry & Obs.
Sorry to miss lead you, brittle diabetes is diabetes insipidus. No DDAVP for type 1 needed. I was bringing up miss leading information to stimulate the conversation. Whoops, forgive me.

Excuse me, but I don't need to be misled in order to be stimulated to converse. What could have been a GREAT thread just went in the toilet for me :o

PLEASE DO NOT FORGET SEVERE ABDOMINAL PAIN:o THIS PAIN WILL MAKE A PERSON :bluecry1: I AM TYPE 1 AND DKA IS NO FUN.

I didn't. It is generally due to the severe depletion of potassium. Neither state is fun for the individual suffering from them. And suffering from them is not necessarily caused by non-compliance. It is so much easier to blame the patient then to find out why.

GRANNYNURSE:balloons:

Excuse me, but I don't need to be misled in order to be stimulated to converse. What could have been a GREAT thread just went in the toilet for me :o

No one should be posting intentionally misleading information on this or any other thread. There are more than enough legitimate ways to stir the pot without resorting to dishonesty.

Thank you.

Specializes in Pediatrics (Burn ICU, CVICU).
I didn't. It is generally due to the severe depletion of potassium. Neither state is fun for the individual suffering from them. And suffering from them is not necessarily caused by non-compliance. It is so much easier to blame the patient then to find out why.

GRANNYNURSE:balloons:

GRANNYNURSE,

I am just a student, but you seem really knowledgable about this topic. I see where another poster said that DKA can cause life-threatning HYPERkalemia; however, you spoke of abd pain due to HYPOkalemia.

Which one is right?

Specializes in Pediatrics (Burn ICU, CVICU).
Excuse me, but I don't need to be misled in order to be stimulated to converse. What could have been a GREAT thread just went in the toilet for me :o

Totally agree. Why would a nurse, who is supposed to be a professional, do such a thing? What if someone, with no medical background was reading this thread and took your information to heart?

That's just ludicrous...not a great way to make conversation or friends.

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