A Diabetic rant

[veggie530]

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

[adnrnstudent, ASN, RN]

I am a Type 2 Diabetic and dependent on Novolog-Lantus. I just saw this post and want to comment more, but don't have time to say all I want to say. I will be back on this subject.

[merlee]

There are many people who don't understand how different insulins work. I am learning more all the time, and I am also a diabetic as well.

I have been working with a Pharm.D. who has explained many things to me, including the entire issue of baseline insulin.

As a group, we don't know as much as we need to about diabetes and insulin.

[TiffyRN, BSN, PhD]

You are right, the general floor nurses knowledge of diabetes and insulin control is just enough to get by (and obviously sometimes not enough).

I didn't learn about the cellular level of glucose insulin until about 6 years ago (and more than 10 years nursing experience) when I had some elevated glucose levels (that thankfully responded to weight loss). I was in adult care for 9 years and I obviously should have known more.

I would have been nervous to give any kind of insulin with a glucose of 56. I would have called the doctor. If the doctor had educated me on the need to continue baseline insulin, I would have happily given it, but you say the MD ordered the insulin be held.

I'm glad there are nurses like yourself that can help educate us more in details.

[OB-nurse2013, BSN, RN]

I agree with you although I have not experienced this first hand my cousins husband is a Type 1 diabetic and he has had similar problems when he has been hospitilazed in the past. My cousin kind of manages everything for him daily and he does well but my cousin always asks why it seems like there isn't a lot of knowledge, when they're at the hospital, about managing dm.

[fallinnstyle]

I am one who will admit being very hesitant to give any kind of insulin for BS=56. While I would intervene and follow the hypoglycemia protocol, I would definitely notify the MD and make sure the BS level is back to normal before giving the lantus.

I agree that this is not a topic well drilled into floor nurses. We are taught to respond to RIGHT NOW and manage the consequences later.

I will say however I have seen nurses refuse to use their critical thinking skills involving giving/holding insulin and their patients woke up (or failed to wake up) with critically low BS

[morte, LPN, LVN]

geesh, i work long term care, and I know better....

[adnrnstudent, ASN, RN]

So there are a lot of questions here. Was the sugar that high because Lantus was withheld or did patient end up having a Somogyi? While Lantus is a basal insulin, I personally get about a 60 point drop from initial injection.

What I would have wanted to do for that patient is get their sugar up. Make sure we were 5 hours past rapid insulin (Novolog or Humalog) and then injected the Lantus.

I wouldn't have been comfortable giving that injection with patient at 56, but I would be comfortable if I new on-board bolus was wore off and sugar was say maybe at least 100.

[SHGR, MSN, RN, CNS]

It is indeed very sad how little many docs/ providers know about diabetes and insulin; don't even get me started about home care nurses with their sliding scales. I think the quickie glucose check/give SS insulin must be a cash cow for some of the unscrupulous ones.

[Blufea]

I take Lantus as well and I know what you mean. I was in the ER once for High BG and the MD made me eat a white bread sandwich and gave me 2 units ofNnovolog. wth. These guys need to hit the books or something. Do some research. Seriously.

[Been there,done that, ASN, RN]

Glycemic control should be a concern for all nurses. Diabetes and blood sugar regulation is a 24/7 issue.

Sadly, there is not enough critical thinking going on. The issue becomes...how should this PARTICULAR blood sugar reading be handled.

I think the answer is an evidenced -based protocol that is policy.

[Dixielee, BSN, RN]

I hope this attachment works. I took a diabetic resource nurse course last year and for my project, I made cards regarding types of insulin and their actions. They fit in a plastic sleeve to wear with your name tag. I refer to mine a lot! I gave them to all of the nurses in the ED. It has been most useful! If this attachment works, you are more than welcome to use them.

There are good resources out there that can be made into pocket cards for quick reference.