Experiences with Diabetic Patients

Nurses General Nursing

Published

Hi,

I'm just wondering if anyone wouldn't sharing their experiences dealing with diabetic patients. What were the patients' perception of health? How did their experiences affect you as a nurse?

or

You yourself, have diabetes, so how do you personal experience help / hinder your role as the health care provider?

That diabetics can't eat sugar and that they don't try to take care of themselves.

Specializes in Endocrine (Diabetes), Pediatric Psych.
That diabetics can't eat sugar and that they don't try to take care of themselves.

That along with the fact that I always get, "But can't you take pills for that?" It would be true, but only for Type 2 Diabetes. The misconception being that only Type 2 exists - there are TWO types of diabetes - many of us don't have that option!

~Adria

Your Top 10 is 100% true, thank you.

I was diagnosed with diabetes at the age of 6, and I'm now going on 20 (Type 1). I did MDI for almost 8 years, and I'm now on insulin pump therapy, which I've been doing for about 6 years now, which I love...never, NEVER going back to injections. I usually check blood sugars at least 8x/day, but it usually runs around 10-12x when all is said and done, quite frankly, I think it's worth it, and I have the confidence of knowing 9 times out of 10, the numbers will be in range...as of now, no complications...

I'm compliant now, but I've gotta say that it wasn't always that way - I've been through about every variation (creative and not so much) of denial in the book, diet, exercise, testing blood sugars, you name it, so I can definitely understand where people are coming from when they aren't compliant. I don't approve of it, but I do understand...for some people, being scared into complying by complications doesn't cut it (especially for teenagers) - the way they look at it, they figure they're going to die anyway, as awful as it sounds, but I know people where that's been the case...

This along with the fact that sometimes, they don't have the appropriate "role model" - if you have an endo who always looks down on you and never encourages you, then I don't blame the patient for not taking care of themselves, as they don't have the appropriate encouragement to want to change - which brings me to that, whoever said this, I agree - the patient has to want to change, an endo can't make them change. And yes, it is frustrating to have a patient who won't do the right thing - I'm not an RN-CDE yet, but I have been a diabetes camp counselor, and you do get kids who come in and are like, "When I go home, I won't be testing my blood sugars...", and we counselors and educators are nothing short of terrified to let them go...so yes, that is very true...

To answer this question - in the near 15 years I've been diabetic, I've learned that it's really a gift that a GOOD endocrinologist has that makes them so awesome - right now, I have a NP diabetes educator who has had diabetes herself for 30+ years, and she has literally made all the difference (as well as determining my career choice - studying to be a nurse and diabetes educator, lol!) Not that I'm saying that the endo I had before was horrible or anything (she was great), but seeing eye-to-eye from another person with diabetes is priceless - I'm all for having more CDE's/endocrinologists with diabetes! :)

I found the following list online - humorous, but very true down to the last word:

The Top Ten Things Every Endocrinologist/CDE Should Know:

1. The last month of readings hold no clues to what the final A1c will reveal. (Evidenced by myself, it seems that when I run numbers in the 200's, my A1c turns out 7's - numbers in the hundred’s, it runs in the 8's...)

2. To be liked by your patients - NEVER scold them about what they eat. We’re not stupid, nor are we super-human.

3. Pumping is the Ivy League school of diabetes care (elite). Don’t tell your type 1 (or type 2) patients it won’t work for them, but make sure they know it will take work.

4. Some individuals will never achieve A1c’s under 7 - this doesn’t represent a character flaw. They are trying their hardest...

5. Every good thing takes (lots of) time and money. (Such as a cure...)

6. Type 1 and Type 2's are very different. (Duhh, but some endos have not yet grasped this concept)

7. If you tell your young adult patient not to do something because they have diabetes, it is strongly likely that they’ll do it...

8. Overeating on hypos are a major source of weight gain.

9. Chocolate should be on everyone’s meal plan – its antioxidant, antidepressant, and medical benefits yet undiscovered outweigh the sugar/fat disadvantages.

10. Some people are destined for complications; other people will live till 80 and not get any. It’s all in the genes that gave you diabetes in the first place.

Ok, I think I got everything, but if you want, feel free to ask more questions!

~Adria

Misconceptions:

1. Borderline Diabetes. No such animal! That is like being a little bit pregnent. Either you have a problem with your metabolism or you don't.

2. That by losing weight you can cure your Type 2 diabetes. I get really angry when docs tell my patients this. :angryfire You can control it with diet and exercise but not cure it.

There are lots more, but those are the two that really drive me nuts.

Now on to Pet Peeves about DM care.

!. Docs that don't want their patients to test their blood sugar. It makes it a lot harder for me to teach them if they don't know where they are.

2. Why the government will give free needles to drug addicts, but Medicare will not pay for syringes for diabetic patients. :angryfire I guess the US govt in its infinite wisdome would rather pay for amputations, dialysis, and seeing eye dogs.

Okay I'll get off of my soapbox now.

There is a lot information about diabetes like diet, glucose monitoring, support groups, treatments etc ... what do you think is the biggest misconception about diabetes (from people who do have diabetes and from the people who don't)?
Specializes in Emergency Dept, M/S.

Wow! I'm surprised at the number of people here dx'd w/Type 1 at a "late" age. I was a late-bloomer also, at the ripe age of 29. I was on MDI for several years, and on the pump now about 4. It is a life-saver, and never-ever-ever would I give it up and go back to MDI. :)

I also had to endo-shop. Nothing makes a diabetic feel worse than being chastised by their doc for one high A1c or not filling in their log book completely, or having too many lows, etc. I am basically a very compliant person, but can be brittle, which was construed as non-compliance. I can go high with ANY stress - a nursing exam, stress of my divorce, heck, even when I go out for a good run, I can go high. Mostly it's in check, but it was incredibly frustrating to have my regular doc or NP jump down my throat for not knowing my last A1c off the top of my head.

The endo that put me on my pump is the bestest doc I've ever seen - hands down. Even if he moved to the other coast, I'd probably fly out to see him for appts every 3 months! He spends time each year on a pump (saline, as he's not diabetic), just so he "knows". He doesn't judge or belittle. He encourages, remains accessible via phone or email. He's understanding that sometimes life gets in the way of diabetes, and diabetes gets in the way of life. But together we work to correct any imperfections, and realize there can and will be more around the corner.

And my biggest pet peeve? Even among 2nd year nursing students (none that I go to school with, but some that were working at a facility I go to), those that don't know that I DID NOT CAUSE MY DIABETES BY EATING TOO MUCH SUGAR!!! I know diabetes and the causes can be a complicated thing to learn, but come on --I thought that thinking went out with bouffant hair-do's!

Question to nurses with diabetes: Do you tell your diabetic patients that you are? I've had a few diabetic patients in clinical, but never passed on any personal information about myself like this. But I sometimes wear my pump on my waistband instead of in a pocket like I normally do, and I don't mind saying it's an insulin pump, but I wondered if sharing how many times you check your BS or when you check, etc. is something you may share to get them talking about it. The reason I ask is because one of the office nurses in my endo's office does share about her diabetes with patients.

The late onset of Type 1 is one of the reasons we no longer call it Juvennile diabetes.

And yesy, my patients know that I am a diabetic and that I struggle with the same issues that they do on a daily basis. Most appreciate that.

Wow! I'm surprised at the number of people here dx'd w/Type 1 at a "late" age. I was a late-bloomer also, at the ripe age of 29. I was on MDI for several years, and on the pump now about 4. It is a life-saver, and never-ever-ever would I give it up and go back to MDI. :)

I also had to endo-shop. Nothing makes a diabetic feel worse than being chastised by their doc for one high A1c or not filling in their log book completely, or having too many lows, etc. I am basically a very compliant person, but can be brittle, which was construed as non-compliance. I can go high with ANY stress - a nursing exam, stress of my divorce, heck, even when I go out for a good run, I can go high. Mostly it's in check, but it was incredibly frustrating to have my regular doc or NP jump down my throat for not knowing my last A1c off the top of my head.

The endo that put me on my pump is the bestest doc I've ever seen - hands down. Even if he moved to the other coast, I'd probably fly out to see him for appts every 3 months! He spends time each year on a pump (saline, as he's not diabetic), just so he "knows". He doesn't judge or belittle. He encourages, remains accessible via phone or email. He's understanding that sometimes life gets in the way of diabetes, and diabetes gets in the way of life. But together we work to correct any imperfections, and realize there can and will be more around the corner.

And my biggest pet peeve? Even among 2nd year nursing students (none that I go to school with, but some that were working at a facility I go to), those that don't know that I DID NOT CAUSE MY DIABETES BY EATING TOO MUCH SUGAR!!! I know diabetes and the causes can be a complicated thing to learn, but come on --I thought that thinking went out with bouffant hair-do's!

Question to nurses with diabetes: Do you tell your diabetic patients that you are? I've had a few diabetic patients in clinical, but never passed on any personal information about myself like this. But I sometimes wear my pump on my waistband instead of in a pocket like I normally do, and I don't mind saying it's an insulin pump, but I wondered if sharing how many times you check your BS or when you check, etc. is something you may share to get them talking about it. The reason I ask is because one of the office nurses in my endo's office does share about her diabetes with patients.

... what do you think is the biggest misconception about diabetes (from people who do have diabetes and from the people who don't)?

I agree, the biggest misconception is that you get diabetes by eating too much sugar.

After being diagnosed with diabetes, how has your perception of health changed? Do you considered yourself to be healthy (did you, prior to your diagnosis)?

I'm a Type 2 diagnosed about five years ago. One of my biggest gripes has been clinicians who don't bother to connect with me or assess my knowledge level before loading me with information and restrictions.

Just because providers have a heightened sense of urgency doesn't mean their newly-diagnosed patients are going to feel the same way. Some of these people--docs, nurses, diabetic educators--are giving answers before the patient has even had time to think of the questions. This is ineffective at best and intrusive at worst.

I would love to see the clinician take the time to talk to the patient and ask a lot of questions. What does this diagnosis mean to you? Do you know anyone who is diabetic? What have you seen take place with them? Are there any particular fears that you have about diabetes? What kind of health would you like to have five or ten or fifteen years from now? Do you want to have children? What level of health is acceptable to you? And so on.

It's important for docs and nurses to realize that they are only collaborators with the patient. Their priorities may not be the same. And, frustrating as it might be for the professionals, they can't override the patient's ability or willingness to comply. In fact, trying to do so may set up a power struggle that can only damage the relationship, not to mention the patient's long term health.

For all age groups, but particularly for adolescents, I would like to see some kind of visual aid that maps out possible pathways in relation to levels of compliance. I would like to see goals (healthy pregnancy, keeping sight, keeping healthy limbs, avoidance of neuropathy, etc.) put in terms of what kinds of actions the person can look at NOW to make these possibilities more likely. I would like to see a progression chart that fills in the blanks between the extremes--complete health on the one end and blind, double-amputee dialysis patient on the other. There are many, many smaller changes that can occur along the way. Ironically, the worst case scenario might not "get in" because it seems so remote, but tell a teenage boy that there may come a time when he can't feel the controls to his X-Box or be able to drive and that can pack more of a punch because it sounds more possible and more relevant.

Every restriction or caution should be explained to the patient in relation to HIS/HER personal goals, as if those actually matter to the clinician. Some people aren't going to comply no matter how well things are explained or how much respect they are shown. But I suspect that there are patients who "do their own thing" mainly as an exercise in autonomy because that is easily taken away from them by well-meaning but overbearing medical folks.

Of course, we want to encourage healthy behavior and push for choices that will prolong full function as long as possible. But WE as providers don't have to count the cost of the the behavior and the choices.

I think we would have a higher compliance rate if we skipped the power struggle and the shaming and the subtle (but not really) judgments and chose to respect the fact that our patients' lives really do belong to them. If we gave them honest education along with information about various tools and meds and the encouragement to use them, they might feel a whole lot more invested in their treatment and their outcomes. After all, if someone else is taking over, then it becomes their problem. The only hitch to that is that THEY will not be the ones dealing directly with the consequences.

Even with adolescents--heck, especially with adolescents--I think the smartest thing a doc or a nurse can do is to say, "You tell me what kind of health you want to have and how hard you're willing to work to achieve it and I'll help you map out a strategy to get there." This implies that the patient still "owns" the condition, but that he has an ally to assist him in dealing with it. If the kid really messes up, the provider needs to be able to say, "Wow, you really had a tough time sticking to your plan. Did your goals change? How can I help you go on from here?" This takes the provider end of the tug of war rope and hands to to the patient. That means the entire struggle is now inside the person it stands to affect the most and that is right where it has always belonged.

I believe one reason that many people are so terribly non-compliant, even unto gross deformity and premature death, is because they have been wrestling with a provider instead of with themselves. If you can locate your conflict outside yourself, you don't ever really need to come to terms with the struggles in your own mind and spirit. And the sad thing is, too many docs and nurses (and family members) are exceedingly willing to step into the role of the glucose police.

Not one of the many tools available to help diagnose and manage diabetes means a pile of chicken feathers if this internal battle isn't fought. Unfortunately, only a relatively small number of medical people understand that this is where all the leverage lives. If they DID understand it, they'd immediately start approaching their patients differently and building mental and emotional health at the same time as they're improving physical health.

I'm grateful for those practitioners--some of mine among them--who do understand the concept of patient-owned diabetes treatment. It asks a lot of a person to resist the urge to take over when they know they could undoubtedly do a much better job than most of their patients. It must be a little like what Jesus went through leaving the Gospel in the hands of a dozen bumbling humans, but truly, it's the only way patients are going to really know what they are up against and develop the motivation to fight their own battles.

I didn't mean to get so long-winded. I just see providers as a HUGE (and unacknowledged) part of the whole compliance issue. I wish they understood how the tremendous combination of patient autonomy and provider respect coulds open the doors to the rest of the orificenal they possess to fight this awful disease.

Eilana,

Although I have a chronic incurable disease, in many ways I am healthier now than before my dx. I try to eat right, and exercise 5-6 days a week. I never did either of those things before my dx.

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