Diabetic Pet Peeves

grannynurse FNP student · Mar 15, 2006

GRANNYNURSE,
I am just a student, but you seem really knowledgable about this topic. I see where another poster said that DKA can cause life-threatning HYPERkalemia; however, you spoke of abd pain due to HYPOkalemia.
Which one is right?

According to my path professor, my textbook and journal articles the abdominal pain is cuased by and related to potassium depletion. There is HYPERglycemia present but the accompanying dehydration results in the depletion of potassium from the body. And that generally causes the abdominal pain. The hyperkalemia comes into play because a patient with hyperglycemia is prevented from absorbing of potassium into the cells-hence hyperkalemia in the blood. The lack of potassium intercellularly causes the pain. When insulin is administered, in treatment, the potassium moves from the extracellular spaces to the intercellular causing blood potassium levels to drop. Confusing isn't it :uhoh3:

Grannynurse:balloons:

RazorbackRN, BSN, RN · Mar 15, 2006

According to my path professor, my textbook and journal articles the abdominal pain is cuased by and related to potassium depletion. There is HYPERglycemia present but the accompanying dehydration results in the depletion of potassium from the body. And that generally causes the abdominal pain. The hyperkalemia comes into play because a patient with hyperglycemia is prevented from absorbing of potassium into the cells-hence hyperkalemia in the blood. The lack of potassium intercellularly causes the pain. When insulin is administered, in treatment, the potassium moves from the extracellular spaces to the intercellular causing blood potassium levels to drop. Confusing isn't it
Grannynurse:balloons:

Very confusing, but you explained it in a way that makes sense.

Thanks!

lsyorke, RN · Mar 15, 2006

Sorry to miss lead you, brittle diabetes is diabetes insipidus. No DDAVP for type 1 needed. I was bringing up miss leading information to stimulate the conversation. Whoops, forgive me.

Nope, "brittle" diabetes and diabetes insipidus are two completely different diseases.

rn/writer, RN · Mar 15, 2006

Totally agree. Why would a nurse, who is supposed to be a professional, do such a thing? What if someone, with no medical background was reading this thread and took your information to heart?
That's just ludicrous...not a great way to make conversation or friends.

This matter has been addressed behind the scenes with a satisfactory result.

rogramjet · Mar 15, 2006

I have a few pet peeves of my own. I am a Type 2 who is a nurse and a diabetic educator.

#1 that type 1 is worse than type 2. These are 2 different diseases with the same outcome...high sugars. Niether one is worse than the other, niether one is harder to control than the other. It depends on the person and their compliance. Both diseases equally effect our organs, and cause the same complications if unmanaged. Type 2s with severe insulin resistance are hard to control I have had patients on 300 units of insulin a day and still running in the 300's with their bg. It's very hard to lose weight with that much insulin on board.

#2 is the "Borderline Diabetes" myth. As far as I'm concerned, that's like being a little pregnant. Either your metabolism is working or it's not. If we could get insurance companies to allow us to see patients at this early stage, and doctors to be more agressive, we could reduce a lot of diabetic complications. I guess insurance companies would rather pay for prosthetic legs, dialysis, and seeing eye dogs, than my meager charges to help prevent these complications.

Alright I'll step off my soap box now.

grannynurse FNP student · Mar 15, 2006

I have a few pet peeves of my own. I am a Type 2 who is a nurse and a diabetic educator.
#1 that type 1 is worse than type 2. These are 2 different diseases with the same outcome...high sugars. Niether one is worse than the other, niether one is harder to control than the other. It depends on the person and their compliance. Both diseases equally effect our organs, and cause the same complications if unmanaged. Type 2s with severe insulin resistance are hard to control I have had patients on 300 units of insulin a day and still running in the 300's with their bg. It's very hard to lose weight with that much insulin on board.
#2 is the "Borderline Diabetes" myth. As far as I'm concerned, that's like being a little pregnant. Either your metabolism is working or it's not. If we could get insurance companies to allow us to see patients at this early stage, and doctors to be more agressive, we could reduce a lot of diabetic complications. I guess insurance companies would rather pay for prosthetic legs, dialysis, and seeing eye dogs, than my meager charges to help prevent these complications.
Alright I'll step off my soap box now.

Type 1 vs Type 2 is an argument used by those who are generally not as knowledgeable as some others. Compliance does play a role in the prevention of the complications of this disease but it does not solely prevent them. And compliance or non-compliance is not a matter of simple choice made or not made by an individual. One of my pet peeves the the blaming of the complications on the patient and his/her supposed non-compliance and that it is a willful choice. It reminds me of another pet peeve of mine, blaming a patient for reappearance in the ER after being discarged with a handul of scripts. Scripts that are expensive and no attempt is made to find out if one can afford them. The insulin resistent aspect of Type 2 affects approximately 25% of those diagnosed with Type 2(not my number but research). It is not as prevalent but it does make the treating of this disease difficult.

The prevention of the complications of any chronic disease takes second place with most health insurance companies and many facilities and physicians. More money is paid out to handle the complications and this makes them more profitatable to the facilities and physicians then to prevent them thru continued education.

Grannynurse:balloons:

rogramjet · Mar 15, 2006

I agree with you that not all complications can be prevented. But the risk can certainly be reduced. Daily foot exams can reduce amputations by 50%. Proper eye treatment can prevent blindness by 90%. A 1% decrease in A1c can reduce the risk of complications by 40%. We may not be able to prevent them, but we can sure reduce them.

Actually I don't agree with the study that says that only 25% of diabetes is related to insulin resistance? That number is far too low. Lots of things make us insulin resistant, stress, weight....from my professonal experience that number needs top be much higher.

The key is education. I have that a lot of "non-compliance" comes from lack of knowledge about the options that are out there for us. We have to treat each patient as an individual.

Type 1 vs Type 2 is an argument used by those who are generally not as knowledgeable as some others. Compliance does play a role in the prevention of the complications of this disease but it does not solely prevent them. And compliance or non-compliance is not a matter of simple choice made or not made by an individual. One of my pet peeves the the blaming of the complications on the patient and his/her supposed non-compliance and that it is a willful choice. It reminds me of another pet peeve of mine, blaming a patient for reappearance in the ER after being discarged with a handul of scripts. Scripts that are expensive and no attempt is made to find out if one can afford them. The insulin resistent aspect of Type 2 affects approximately 25% of those diagnosed with Type 2(not my number but research). It is not as prevalent but it does make the treating of this disease difficult.
The prevention of the complications of any chronic disease takes second place with most health insurance companies and many facilities and physicians. More money is paid out to handle the complications and this makes them more profitatable to the facilities and physicians then to prevent them thru continued education.
Grannynurse:balloons:

June55Baby · Mar 15, 2006

Thank you for starting this thread! I agree with all the pet peeves list below.

Type 1 here and have been for 21 years with adult onset at the age of 30. Also been using a pump for 12 years. The pump is the only way to go for me. It has given me more freedom and been a big factor in helping me achieve glucose control. I have also been able to educate healthcare professionals that I associate with about diabetes management, pumps, and carb counting.

I am thankful everyday for the strides that have been made in diabetes management, for the healthcare professionals who care for me and for the insurance that pays for my medication and supplies!

grannynurse FNP student · Mar 15, 2006

I agree with you that not all complications can be prevented. But the risk can certainly be reduced. Daily foot exams can reduce amputations by 50%. Proper eye treatment can prevent blindness by 90%. A 1% decrease in A1c can reduce the risk of complications by 40%. We may not be able to prevent them, but we can sure reduce them.
Actually I don't agree with the study that says that only 25% of diabetes is related to insulin resistance? That number is far too low. Lots of things make us insulin resistant, stress, weight....from my professonal experience that number needs top be much higher.
The key is education. I have that a lot of "non-compliance" comes from lack of knowledge about the options that are out there for us. We have to treat each patient as an individual.

Research has demonstrated the approximately twenty five percent. I am sorry you do not agree and it perhaps it has not been your experience but research clearly demonstrates it. Non-adherence is more then just a lack of education. It is also a matter of acceptacence of the disease by the individual, their SO, their family, their employer.

IR is a metabolic syndrome, not just a diabetic one, that consists of a cluster of metabolic abnormalities that put people at risk for cardiovascular disease, polycystic ovary syndrome and nonalcoholic fatty liver disease. And diabetes. In other words, diabetes is a result of a cluster of these conditions.

Grannynurse:balloons:

grannynurse FNP student · Mar 15, 2006

I'm sorry I meant diabetes is one of the clusters of disease. IR is a disorder that is associated with this cluster.

Grannynurse

rogramjet · Mar 15, 2006

I agree that a lot of so called non-compliance is about non-acceptance by the pt, family...etc. But how do we get them to accept it? Through education. If a person knows the consequences of uncontrolled diabetes they are more likely to manage it. Remember the old saying keep your friends close and your enemies closer. The more educated we are the more apt we are to control it. I have seen many patients who were in complete denial until they attended our class. I know I can't save them all, after all you can lead a horse to water, but you can't make him drink...but if we can educate them, and we can show them the dangers of non-compliance we may save a few. Unfortunately diabetes has no pain involved...until they start hacking off limbs, or strapping you to a dialysis chair...it is easy to get complacent. In a nutshell, what I'm trying to say is, one way to get them to accept the disease is to educate them, some will be non-compliant anyway, but we do what we can.

grannynurse FNP student · Mar 16, 2006

I agree that a lot of so called non-compliance is about non-acceptance by the pt, family...etc. But how do we get them to accept it? Through education. If a person knows the consequences of uncontrolled diabetes they are more likely to manage it. Remember the old saying keep your friends close and your enemies closer. The more educated we are the more apt we are to control it. I have seen many patients who were in complete denial until they attended our class. I know I can't save them all, after all you can lead a horse to water, but you can't make him drink...but if we can educate them, and we can show them the dangers of non-compliance we may save a few. Unfortunately diabetes has no pain involved...until they start hacking off limbs, or strapping you to a dialysis chair...it is easy to get complacent. In a nutshell, what I'm trying to say is, one way to get them to accept the disease is to educate them, some will be non-compliant anyway, but we do what we can.

Your providing a class is just one small portion of the education process. Preventing the complications of diabetes is a group effort. In Hawaii, there is a health center that provides a multifaceted approach to their care and treatment of Hawaiian diabetics, including orangized helper shoppers who assist them in making the appropriate selections for their diet. They also provide screening and education clinics, as well as in home education. And it is often repeated, even for those that think they already know what they need to know.

I have been a diabetic for more then 15 years. I have been a nurse since 1967. I still go to classes, in my community and to support groups. I hope to do my thesis on an aspect of the non-adherence of Type 2 diabetics, why and what can be done to change the situation. I do not have the answers but I do know that education is only a part of the issue of non-adherence.

Grannynurse:balloons: