Diabetic Pet Peeves

gwenith, BSN, RN · Mar 16, 2006

Question - Are you in the US advocating the use of the Low GI diet in Diabetes??

Multicollinearity, BSN, RN · Mar 16, 2006

I do not have the answers but I do know that education is only a part of the issue of non-adherence.
Grannynurse:balloons:

Granny,

I think some underestimate the simple fact of so many people not adhering simply because they don't have coverage and don't have $$s yet don't qualify for Medicaid. I know a woman, in her 60's who is suffering with multiple medical problems including diabetes, yet doesn't quite qualify for disability. She is taking care of her husband who is sicker than her. They are both living large ( :nono: ) on $1200 per month. She would love to comply or adhere or whatever but she simply doesn't have the money. She tried to purchase a health insurance policy on her own (she was going to rent a room in her house to pay for it) but of course no insurer will take her. I just cannot fathom that we continue to let this occur in the US.

Midwest4me · 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."
quote:" ...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...some will be non-compliant anyway, but we do what we can.

My husband is a type 2 diabetic but takes Insulin 70/30 twice a day(started only a few mos. ago) as well as Glucophage. He's been on an doff a # of oral antidiabrtic agents prior to being placed on insulin. He HAS been educated by others and by me and continues to be noncompliant in my opinion----he is to have a phone mtg with a nurse manager once a week during which he tells her his recent CBGs,etc but often doesn't answer the phone when she calls as he dislikes being lectured for an hour by her! He doesn't take his CBGs as often as he should (maybe 2x a day if that) and says"I'll starve to death on a fourth cup of this or half cup of that" so I let him eat as he chooses---I'm done lecturing him---I worry about the comlpications--I used to work in dialysis with diabetics and have warned him of the problems---(he also has hypertension and hypothyroidism)but education has to be HEEDED to work!

oldnurse newnurse · Mar 16, 2006

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

I concur brittle diabetes and Diabetes Insipidus are two completely different things.

bjs54321 · Mar 16, 2006

Maybe it's my alzhiemer's but I stand corrected. I appreciated all who have contributed to this forum. I was hoping to learn and I am. My photographic memory has failed me, so I stand corrected. And I have re-openned my dusty book. After all, education is the key!

Taken from my "Management of Diabetes Mellitus: Perspectives of Care Across the Life Span". Author:Debra Haire-Joshu

Pg 372:

"Brittle Diabetes-should be reserved for those cases in which diabetic instability is manifest by recurrent episodes of ketosis or ketoacidosis or severe hypoglycemia, or both, and is significant enough to result in an inability to maintain a normal life-style or to endanger life. It is not appropriate to use the term to describe patients with stable diabetes who maintain relatively normal life-style despite less than optimal glycemic control with persistently elevated or widely fluctuating blood glucose. Rather, persons with brittle diabetes are frequently absent from school or the work place and are often visiting emergency rooms or are hospitalized."

"Brittle diabetes is almost exclusively limited to subjects with IDDM and is rarely seen in subjects with NIDDM. It occurs more commonly among females than males."

My next wonder of the diabetic world: Why do I have less insulin requirements both in basal and bolus rates when I have my menses? This is where the hormones must play a role. That's only a theory.

rn/writer, RN · Mar 16, 2006

I think one of the biggest obstacles to "compliance" (geez, I hate that word), is that you can use all the scare tactics in the world, show pictures of gangrenous feet about to be lopped off and post-mortem shots of shriveled kidneys, tell horror stories about blindness and heart attacks and neuropathy, cite statistics about early death, and all the rest, and it JUST DOESN'T GET IN.

Why? Because it's theoretical. It's out there somewhere applying to all those other people.

We need to find ways to show people what is happening to them, inside their own bodies, to mark the wicked progression in ways that make it real that this isn't something out of a textbook or a government pamphlet, but changes that are taking place right now to them.

With gentle but thorough questioning we need to help patients evaluate their energy level, changes in sensation, and even their sexual function. If they can begin to see the micro-alterations occurring to THEM the rest of it may finally seem real.

Then, once they have this personalized awareness, we need to ASK them what they want for their own future. Some patients are willing to combine constant vigilance and vigorous efforts in pursuit of nearly perfect numbers. Others are less so. It isn't for us to decide which route they will take. They are the ones who have to live with the work and the consequences.

Too much of diabetic education and monitoring is adversarial. All that attitude does is build opposition and defensiveness. Patients end up not only insulin-resistant but help-resistant as well. There is an all-too-pervasive lack of respect for diabetic patients that often starts out being patronizing and ends up with both sides exasperated.

Two things are necessary to overcome this exercise in frustration. First, teaching methods that supercede denial and help each patient evaluate the very personal course the disease is taking inside them, and second, the recognition that the battle belongs to the patient, not the doc or the nurse or the educator. Even an effectively informed patient may still make the "wrong" choices. We need to be okay with that, even as we communicate sadness because they matter to us.

bjs54321 · Mar 16, 2006

Diabetic Pet Peeve#????

Nurses...diabetic nurses who think they know it all. GEEZ:uhoh3:

I'm the first in that line....thanks for the education!

grannynurse FNP student · Mar 16, 2006

Granny,
I think some underestimate the simple fact of so many people not adhering simply because they don't have coverage and don't have $$s yet don't qualify for Medicaid. I know a woman, in her 60's who is suffering with multiple medical problems including diabetes, yet doesn't quite qualify for disability. She is taking care of her husband who is sicker than her. They are both living large ( ) on $1200 per month. She would love to comply or adhere or whatever but she simply doesn't have the money. She tried to purchase a health insurance policy on her own (she was going to rent a room in her house to pay for it) but of course no insurer will take her. I just cannot fathom that we continue to let this occur in the US.

Because, in this country,health care is not a right, it is a privilege. I do not know how to put it any other way.

Grannynurse:balloons:

HeartsOpenWide, RN · Mar 16, 2006

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.

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....

zacarias, ASN, RN · Mar 16, 2006

Actually if a type 2 person gets to the point where they require insulin, they are type 2 insulin dependent. They don't "become" type 1 if that makes sense.

bjs54321 · Mar 16, 2006

Very true zacarias!

BamaBound2bRN · Mar 16, 2006

Pet Peeve #7- Being diabetic is a health condition, NOT A DISABILITY! I can do anything you can do (usually) and somethings even better- I just have to monitor my diabetes.