Diabetes. The Sugar That's Not So Sweet

FuturisticLadee, LPN

This is based on true experiences from working as a nurse during the night shift in long-term care and rehabilitation centers.

It's 4 AM. Time to begin preparing for the early-morning med-pass (a term we often use for passing out medications during a scheduled time). Gathering breathing treatments from the med room refrigerator. Stocking the med cart with new supplies (drinking cups, medicine cups, spoons, orange juice, thickened liquids and iced water, MedPass nutritional shake, etc.) Now for the main part of this med-pass. The blood sugars.

I am assigned a certain amount of patients on a specific unit out of all the units and patients in the building. At this time, I'm responsible for collecting important data from each diabetic patient who has the blood sugar check schedule before breakfast. Usually, this is scheduled to be taken at 6:30 AM which gives the caregiver a window to collect between 5:30 AM and 7:30 AM. An hour before and an hour after unless specific instructions otherwise.

As I am going through the MAR (medication administration record), I see that I have 11 blood sugar checks along with a few breathing treatments to administer, skin creams to apply, and some pills to give (including tramadol, Synthroid, omeprazole, reglan). So let's get started.

Taking each blood sugar with the patient's individual glucometer. Results range from normal to below and above normal. According to WebMD.com, a normal range for an adult over 20 years of age is 70-130mg/dL before meals and 100-140mg/dL at bedtime.

In my experience, if below 60mg/dL, the patient is usually given 4 ounces of orange juice then check in 15 minutes. In some cases, I've had to administer a glucagon shot to bring the blood sugar up to normal range faster. Also because the patient isn't alert enough to take anything by mouth.

In the event that a reading is 200mg/dL or above, there are usually doctor's orders in place for a sliding scale insulin. According to the reading, a certain number of units are to be given from the prescribed insulin vial. In some cases, there are ordered formulas for this dosage to be calculated.

I've seen these abnormalities happen from either not having a snack at bedtime or having a snack with too much sugar. For example, a patient has blood sugar 285mg/dL and I noticed she had an empty diet soda can on her bedside table. She is alert and oriented and has her own snacks in her room.

This has been a recap of one of my many experiences with taking care of diabetic patients.

There has even been a time at the beginning of my career when I participated in the cold blue of a patient who had a blood sugar reading in the 30s. Although she wasn't my assigned patient, I was a part of the team of all available nurses in the building came together and attempt to resuscitate this patient who was middle-aged at the time. I was working on a rehab hall at the time. When I heard the announcement that was paged over the intercom, I stopped what I was doing which was passing out medications and got the charge nurse to cover. When I arrived, CPR was being performed. During this code, the patient received a glucagon shot as well as other life-saving measures. She was revived, but eventually died due to complications of her chronic illness, type 2 diabetes.

A few years ago, I had a patient, an older lady in her 70s with an unforgettable personality. She already had bilateral BKA (below knee amputation) meaning she had both legs surgically removed. This was due to her type 2 Diabetes. I worked with her on weekends during the night shift from 7PM to 7AM for months. She was scheduled to have her insulin at bedtime then blood sugar to be checked during the early morning med-pass. As ordered, I would give her insulin at bedtime then recheck blood sugar in the morning. She couldn't stand to be awakened so early for this routine and I didn't blame her. She was already getting it done 4 times a day. After the finger stick done to collect the small blood sample for the reading, she would almost always say, "ouch, that **** hurts". I'd apologize and explain why even though she made it clear that she already knew. She was aware that it was something that needed to be done and could be life-threatening if it wasn't.

For me, her readings usually stayed within a normal range so nothing extra had to be done. One evening, I came in for my shift and received report from the dayshift nurse. This patient was in the hospital. She had gone to a family outing and was rushed to the ER. Reason was diagnosed as complications from uncontrolled diabetes. She stayed in the hospital for a few days then I was saddened to hear that she passed away.

I have seen many cases when a patient's diabetes was uncontrolled and many when it was managed by being placed on a special diet with physical activity to be incorporated into their daily lives.

Although it is possible to manage this chronic disease; not having it is ideal. Sometimes it can be prevented. According to a study done on nurses, diet and lifestyle have been proven factors in diabetes prevention.

"Although the genes you inherit may influence the development of type 2 diabetes, they take a backseat to behavioral and lifestyle factors. Data from the nurses' health study suggested 90% of type 2 diabetes in women can be attributed to five such factors. Excess weight, lack of exercise, a less than healthy diet, smoking, and abstaining from alcohol." (The Nutrition Source. Harvard University)

Sources:

WebMD.com

"Simple Steps to Preventing Diabetes." The Nutrition Source. Harvard T.H. CHAN, www.hsph.harvard.edu

Diabetes. The Sugar That's Not So Sweet

About FuturisticLadee, LPN

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