Noncompliant diabetic patients

[ThePrincessBride, MSN, RN, NP]

I work on a med-surg unit with plenty of diabetic patients. Most are noncompliant with high A1Cs and are always demanding cookies.

I try to find a balance. Last week I had a 400 pound patient demanding multiple snacks outside of his diet. He had a wound that wasn't healing and I explained to him that high blood sugar levels could interfere with the healing process. He still demanded that I give him whatever he wanted. I managed to convince him to meet me in the middle and have one of what he wanted instead of two of everything and covered his carbs and blood sugar.

So question: when a diabetic patient demands sweets, has high blood sugars and isn't NPO or clear liquids for a procedure, do you just continue to give them all the snacks they want? Or do you insist that if they want to be noncompliant with the hospital diet that they must get their own treats?

[rearviewmirror, BSN, RN]

there are no hopes in some people... I have seen my plenty of share in the ER where you see frequent fliers come in and the next thing you know, they are missing a limb d/t chronic conditions such as dm. they can do whatever the hell they want, it's not a prison, but they won't get no sweets or snack from me.

[Libby1987]

I have a piggyback question..

Are you allowed to give patient foods outside of the MD ordered diet?

[cardiacfreak, ADN]

It's just not diabetics, I deal with this with our CHFers who are repeat offenders. My saving grace is that they are usually on a fluid restriction. However, I'll see them the next week with 3 + edema.

[ThePrincessBride, MSN, RN, NP]

I have a piggyback question..

Are you allowed to give patient foods outside of the MD ordered diet?

For the diabetic patients, they are usually on a carb-controlled diet but we are not allowed to give insulin outside of the scheduled three meals a day and night time snack. So a patient could be snacking all night after their bedtime dose and not get covered until breakfast.

We technically shouldn't, but because our patient satisfaction scores are so low and our manager has written people up for patient complaints, some of thr nurses end up giving the patients what they want.

[BuckyBadgerRN, ASN, RN]

It's their right to slowly kill themselves! Sucks, but I'm willing to bet that your hospital wants you to run and get whatever they're requesting---customer satisfaction survey's and all dontcha know!

I work on a med-surg unit with plenty of diabetic patients. Most are noncompliant with high A1Cs and are always demanding cookies.

I try to find a balance. Last week I had a 400 pound patient demanding multiple snacks outside of his diet. He had a wound that wasn't healing and I explained to him that high blood sugar levels could interfere with the healing process. He still demanded that I give him whatever he wanted. I managed to convince him to meet me in the middle and have one of what he wanted instead of two of everything and covered his carbs and blood sugar.

So question: when a diabetic patient demands sweets, has high blood sugars and isn't NPO or clear liquids for a procedure, do you just continue to give them all the snacks they want? Or do you insist that if they want to be noncompliant with the hospital diet that they must get their own treats?

[kiszi, RN]

Nope, I tell them I will give them what is allowable on their diet. If they want more, they have to ask family to bring it.

[ThePrincessBride, MSN, RN, NP]

It's their right to slowly kill themselves! Sucks, but I'm willing to bet that your hospital wants you to run and get whatever they're requesting---customer satisfaction survey's and all dontcha know!

Pretty much!

I want to be a good nurse, but at the same time, I don't want a write-up on my record as I plan on transferring eventually. Some of the patients get so pushy that sometimes I just throw my hands up and give them what they want.

[Red Kryptonite]

We technically shouldn't, but because our patient satisfaction scores are so low and our manager has written people up for patient complaints, some of thr nurses end up giving the patients what they want.

What a sandbag! Follow P&P and end up written up?!

For any nurse managers reading this, that kind of crap is what makes your floor staff hate and you and see you as completely unsupportive and out of touch.

[defying.gravity]

I do the best I can, which isn't always good enough from my point of view, and isn't always what I want to do.

I do vigilant assessments and try to treat each patient with a "do no harm" mentality. Sometimes a cookie isn't just a cookie, sometimes a cookie is a self care for a crushed spirit. Not exactly the best choice of self care, but self care, nonetheless. I try to respect that, even if I do not always understand it. That does not mean I will always be the cookie dealer for coping, because I have to also respect my own sense of self and my part to play in the health care of the patient. I don't like playing "cookie cop", but sometimes I do if I think that by taking that course of action I might help the patient in the long term course of care.

If I'm able to educate the patient or point to resources the patient may not be aware of, I try to do that. I have a weakness for the younger patients, I'm a little tougher on them.

Assessment is key, if you ask me. Pay attention to the circumstances that are leading the person to not understand the consequences of their decisions. As nurses, it is very often obvious to us what the consequences are for the variety of choices we make in life. Not everyone really "gets" the cause-effect of the decisions. It takes a lot of patience to explain the same thing over and over, but there is always the chance that the patient takes that information and it means something. You probably won't know one way or another, they probably won't tell you, or they probably won't even know that what you say helped.

Knowing your diabetic resources is helpful. A diabetic educator consult can be helpful if your facility has one on site. Websites can help if the person likes to be online. If I found myself having this issue often, I'd probably have a toolbox of hints and tips for my patients. Diabetic pamphlets, etc. Social work consults or psych consults can be helpful also if you notice the patient might be using food as a form of self care. Those are tricky and can get messy and political, not to jump into those lightly, especially if that is not the role you are in with the patient, but those are tools I would have in my toolbox if I really thought I might be able to help a patient in their long term health care.

Diabetes and obesity in our society has become an epidemic. I hope we can start to help change that trend into a different direction. Nurses are on the front line of that more often than not.

[Libby1987]

Coming from a HH perspective, you won't be changing long held dietary habits so if you wouldn't get in trouble for providing a snack I would avoid increasing the patient's agitation with tight restrictions and focus on educating need for glycemic control and nutrition with adequate protein and nutrient dense plant foods for wound healing.

[BuckyBadgerRN, ASN, RN]

I work in ophthalmology, we see many diabetics. Several with A1C's in the teens. One man comes to clinic in his wheelchair (b/c he's lost both legs d/t diabetic complications) with a bag on the back, FULL of crap snacks. He'll ask for a bag of cheetos or ding dongs that he brings and he'll ask for us to grab something for him from the bag. Nope, absolutely not. We'll check your sugar and give you juice or a cereal bar, if you feel like your sugar is low. Otherwise, no, we will not do that for you. His family will though, if they're along.