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

I am a new diabetic so just starting to do a little more in-depth research on the disease (I know the basics, as a nurse).

In response to "Psychaprn", what is Byetta and how does it help your diabetes? I seem to be having a lot of problem controlling my hunger and weight gain. I am classified "early diabetes" and want to get a quick grip on the situation.

Thanks for any help, suggestions, etc.

Geri

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click on her profile by clicking on her name.

I think that was a rhetorical question.. :)

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Has anyone heard of the DAWN Program? If you have, what have you heard. If not, do you want to know about it?

Grannynurse:balloons:

No, I don't know about it. Please tell me as much as you can. I want as much

good information about diabetes as I can possibly get to make it easier for me to cope with it.

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No, I don't know about it. Please tell me as much as you can. I want as much

good information about diabetes as I can possibly get to make it easier for me to cope with it.

It stands for Diabetes Attitudes, Wishes and Needs Program. It is an international partnership effort to improve outcomes of diabetic care by inreasing the focus on the person behind the disease, especially the psychosocial and behavioral barriers to effective management. A number of studies have identified the possible causes of poor outcomes as being the psychological, social and behavioral.

Grannynurse:balloons:

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Specializes in ICU.
It's being looked into--there is disagreement as to how much it adds to standard carb counting advice as far as improvement in glycemic control. I'm curious to hear what's generally done in Australia as I know the GI is more widely used there.[/quote']

We don't carb count per se. The idea especially for type II diabetics is to avoid blood glucose peaks. The theory is that this allows the body time to deal with the glucose and so it does so more efficiently. You have to wrap your mind though around 2 concepts the Glycaemic index of the food and the Glycaemic load of the meal. eg Potatoes have a very high GI and a big meal of mashed potatoes will skyrocket your blood glucose, so try to avoid them but if you really feel like them you can eat a small amount with some protien like steak and it will slow absorbtion down making the glucose rise smaller. You more or less aim for a steady state with your BSL. A lot of foods now are carrying the low GI symbol and they are starting to make low GI breakfast cereals and drinks. Slowly slowly the message is getting through to the food manufacturers.

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Specializes in Emergency Dept, M/S.
We don't carb count per se. The idea especially for type II diabetics is to avoid blood glucose peaks. The theory is that this allows the body time to deal with the glucose and so it does so more efficiently.

This is very similar to what I was taught when using my pump. I do have to count carbs to bolus, but the G.I. is something I use quite a bit. Like you said, I never eat potatoes, except maybe a few tablespoons at Thanksgiving, because my blood sugar rises dramatically over an hour after consumption.

That said, a lot of nurses I know tend to confuse low G.I. foods with Atkins diet foods. I've never done Atkins, so don't know much about it, but my dietician said it is very different, and can be a common mistake among those not familiar with the glycemic index.

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Specializes in Renal; NICU.

It's surprising that no one picked up on the range for fasting glucose in the first post. 70-120 is no longer seen as the accepted range.

The range is now 65-110. The nearer one gets even to 100 is considered to be a pre-diabetic person. This is what my MD and my husband's are telling us (2 different doctors).

Sooooo, this is something to consider in your patient education. It would seem practical to have number as low as is acceptable anyway. It gives more leeway for the future changes especially if this is a young adult patient.

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Specializes in Med-Surg, Wound Care.

The range is now 65-110. The nearer one gets even to 100 is considered to be a pre-diabetic person. This is what my MD and my husband's are telling us (2 different doctors).

So one has to wonder why the change?? Has anyone seen any scientific studies on this? I'm VERY skeptical when we see a change in a "norm" which makes it almost impossible to achieve that norm without medication.(like the changes in the cholesterol guidelines coinciding with the approval of statins)

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So one has to wonder why the change?? Has anyone seen any scientific studies on this? I'm VERY skeptical when we see a change in a "norm" which makes it almost impossible to achieve that norm without medication.(like the changes in the cholesterol guidelines coinciding with the approval of statins)

I have yet to find any research supporting these new values. I do know, when my fbs is 65 or below I suffer from the symptoms of hypoglycemia. But that is me.

Grannynurse:balloons:

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Specializes in acute care.
We don't carb count per se. The idea especially for type II diabetics is to avoid blood glucose peaks. The theory is that this allows the body time to deal with the glucose and so it does so more efficiently. You have to wrap your mind though around 2 concepts the Glycaemic index of the food and the Glycaemic load of the meal. eg Potatoes have a very high GI and a big meal of mashed potatoes will skyrocket your blood glucose, so try to avoid them but if you really feel like them you can eat a small amount with some protien like steak and it will slow absorbtion down making the glucose rise smaller. You more or less aim for a steady state with your BSL. A lot of foods now are carrying the low GI symbol and they are starting to make low GI breakfast cereals and drinks. Slowly slowly the message is getting through to the food manufacturers.

So how has that been working for people--have they been able to keep their diabetes under good control with this? The glycemic index does make a lot of sense; I'm just surprised that there's no carb counting at all being done along with it--it seems like the best thing might be to combine the two by having a certain percentage of your diet come from carbohydrate and making sure most of that carbohydrate has a low GI. Maybe it depends on whether the person is using insulin or not--if using insulin, CHO counting will definitely still be needed. I have noticed a few food labels here in the US mentioning that the product has a low GI, but it's not widespread here yet.

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Specializes in ICU.

All I can really say is how it is affecting me. About 6 months ago I was diagnosed as mature onset diabetic - so I went on the low GI diet - I have lost around 13 kilos (26+ lbs) with it and my blood sugars astounded my doctor - in a good way:D

I can't compare BSL's because we use a different measure (mmol/L) while yours is..........??? But for us 5 - 10 is ideal range. Now I have just eaten breakfast (bowl of low GI cereal) and my BSL POST breakfast is 8.5 - not even upper limit of normal. I agree it is also about total carbs in the day - especially if you are trying to lose weight but it is an easy diet because it is a substitution diet. Instead of potato eat sweet potato, instead of ice-cream eat yoghurt, choose low GI (Bismati) rice over high GI (white sticky) rice. In general the higher the fibre the lower the GI. (I joke that if my diet was any higher in fibre I would be eating cardboard and dust:p)

Because it is high fibre there are not the side effects of Atkins like constipation and halitosis. (There is however a lot of flatus) It is a diet that does rely more on added protien than some other diets BUT that protien, by preferrence should be a fair proportion of fish.

The diet is actually coming out of research at Sydney University on how different Carbs affect your blood sugar and instead of relying on calculated response they actually measured the response. By doing so they found there were two types of starch. If you are interested in more I will get my Glucose Revolution book and go into it a bit deeper.

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It stands for Diabetes Attitudes, Wishes and Needs Program. It is an international partnership effort to improve outcomes of diabetic care by inreasing the focus on the person behind the disease, especially the psychosocial and behavioral barriers to effective management. A number of studies have identified the possible causes of poor outcomes as being the psychological, social and behavioral.

Grannynurse:balloons:

Thank you! I have just Googled "Diabetes Attitudes, Wishes, and Needs" and

found many sites devoted to the topic.

With a combination of asthma and what my doctor calls "pre-diabetes" I have determined that I need all the help I can get to be able to avoid the albuterol trap of being hungry all the time, craving salt, retaining fluid, and needing to take potassium-sparing diuretics.

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