Diabetic Pet Peeves

Angie O'Plasty · Mar 20, 2006

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.

That explanation makes sense. I'm glad to hear the low GI is working well for you; I've known some other people who have done it and have had good results as well. The "cardboard and dust" comment was amusing :wink2: . Now, to test the GI, they feed a certain number of normal subjects (is it 5 or 10?) a portion of the test food containing 50g of CHO and measure the glycemic response, and then compare that to the response to a control food like glucose or white bread, correct? I'd be interested to know how much inter-individual variation there is in people's responses to a given food--is there a fair amount, or are people pretty similar in how they handle the food, as long as they're metabolically normal?

Retired R.N. · Mar 20, 2006

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:

If my level ever got that low, I doubt that I would be able to notice it because I think I might be just a lump on the floor! :-) I start feeling very queasy when I get down to 75 or so. For now, I consider myself lucky to have such a strong early warning signal.

grannynurse FNP student · Mar 20, 2006

If my level ever got that low, I doubt that I would be able to notice it because I think I might be just a lump on the floor! :-) I start feeling very queasy when I get down to 75 or so. For now, I consider myself lucky to have such a strong early warning signal.

What upsets me is the people who insist that everyone's fbs should be in the 60's or low 70's without taking into consideration the impact of such numbers. It is just now being investigated as to the long term effects of such blood sugars on the body's organs. It has been widely assumed that low blood sugars has no adverse impact. Some researchers are slowly finding out this assumption could be an error. One has to listen to one's own body and use guidelines but not make them GOD.

Grannynurse:balloons:

Multicollinearity, BSN, RN · Mar 20, 2006

Isn't it about balance? Once my BS got down to 32, and I had an idiot resident in the ER telling me there was nothing wrong with me and perhaps I should make an appointment with my family doc to discuss Chronic Fatigue. Idiot. I had no symptoms of Chronic Fatigue, I had raging symptoms of hypoglycemia!

grannynurse FNP student · Mar 20, 2006

Isn't it about balance? Once my BS got down to 32, and I had an idiot resident in the ER telling me there was nothing wrong with me and perhaps I should make an appointment with my family doc to discuss Chronic Fatigue. Idiot. I had no symptoms of Chronic Fatigue, I had raging symptoms of hypoglycemia!

Unfortunately, many medical and nursing professionals are not not current on the current practice and knowledge. I hope someone addressed this residents lack of knowledge. :uhoh3:

Grannynurse:balloons:

Multicollinearity, BSN, RN · Mar 20, 2006

Unfortunately, many medical and nursing professionals are not not current on the current practice and knowledge. I hope someone addressed this residents lack of knowledge.
Grannynurse:balloons:

Yes, I demanded to see the attending. The attending came in and clued in the resident in front of me, then properly treated me himself. It's not routine for me to call anyone an idiot-I just think a medical student should know this-let alone a resident. The resident made me furious by attempting to throw me in that trash can dx, Chronic Fatigue, just because he didn't know what was wrong.

bjs54321 · Mar 20, 2006

I was on my travel assignment this past weekend and while reminiscing with other nurses....an ER nurse told me about an insulin diabetic who injected 300 units of Humalog insulin as a suicide attempt. This pt lived and had no adverse side affects.....unbelievable. I am surprised that this pt didn't end up with brain damage.....

Has anyone encountered this before....I know of a pt who injected 100 units of Humalog and also had the same outcome.

Wow....we are awesome to have situations like this happen and people to be saved intact. I wonder what the stats are for diabetics who become or are being treated for depression and how that correlates to attempted suicides?

bjs54321 · Mar 20, 2006

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.

Our CDEs still recommend 70-120. I need to treat myself for hypoglycemia at 90 sometimes. Of course, I have been as low as 22...per blood draw and still conscious and functioning....I was inpt at the time. I sometimes am symptomatic at 90 and other times I can be as low as 40. 50 and lower is a monster.....

gwenith, BSN, RN · Mar 21, 2006

I was on my travel assignment this past weekend and while reminiscing with other nurses....an ER nurse told me about an insulin diabetic who injected 300 units of Humalog insulin as a suicide attempt. This pt lived and had no adverse side affects.....unbelievable. I am surprised that this pt didn't end up with brain damage.....
Has anyone encountered this before....I know of a pt who injected 100 units of Humalog and also had the same outcome.
Wow....we are awesome to have situations like this happen and people to be saved intact. I wonder what the stats are for diabetics who become or are being treated for depression and how that correlates to attempted suicides?

Many, many years ago I had a young patient - 18 or 19 I think - overdose on his grandmother's oral hypoglycaemics - he was brain dead by the time he reached us - very, very sad case,

Hairstylingnurse · Mar 31, 2006

I love you......I couldn't have wrote your post any better if I had tried. I'm a type 1 diabetic(diagnosed in the last 2-3-yrs) and get sooooo frustated from people that don't know my disease telling me how to live with it when they have no understanding of what all goes into figuring out what and how much of something I can eat (These are actually not health care providers). Your post has sooooooo much truth to it. I'm still learning sooooo much everyday. I have just started on an insulin pump in the last 2 months and it has been a life changing experience for me.

I would love a forum on diabetes.

[/banana]

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

Balder_LPN, LPN · Jun 28, 2006

This is largely because type 2 diabetics refuse to eat right and exercise (which can cure type 2) and instead have damaged their bodies so much that they become insulin dependent....[/i]

You need to bone up on Type 2 diabetes.
Grannynurse:balloons:

Granny, Except for the "largely" part isnt Hearts statement at least mostly true? Diet and exercise may control bs to normal levels in type 2, and that when type 2 has been poorly controlled insulin may become neccesary for control.

Thats the way Ive learned it, but Hearts post was just more generalized maybe.

cinnyluvscats · Jul 1, 2006

I've been an RN for 20 years and have taken care of diabetics, especially gestational diabetics after working 9 years on OB. I'm now on the threshhold of being diagnosed myself. I'd been having the classic symptoms. 2 separate FBS were done at work (local health dept.) and were 131 and 147. Just had blood drawn today for venous FBS and A1C level. Had father and both of his parents who were diabetics - type 2. Was diagnosed with Syndrom X and hyperinsulinemia in mid-90's and was placed on Glucophage. Then got off of it when my endocrinologist left town and the internist I switched to didn't think I needed meds anymore.

Add to all this bilateral knee replacements back in Nov. '05 and being way overweight and you get the picture. (plus other health issues like corrective surgery for scoliosis, osteoarthritis in multiple joints, etc.)

What's a girl to do? Any advice, words of wisdom, etc. would be greatly appreciated. I don't want to face all this but I also want to be around to see my grandkids and to keep working.

Cindy