Diabetic Pet Peeves

Psychaprn · Mar 17, 2006

Brittle Diabetes is the term used for very unstable diabetes mellitus, in my parts of the Country.
Diabetes Insipidus is a very different animal.
Perhaps the OP could clarify?

I agree-I always thought DI was caused by meds-i.e. lithium, steroids, etc. and that it was reversible.

Psychaprn · Mar 17, 2006

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

Yeah, I always thought DI was caused by a med like Lithium or Steroids and was reversible-Anyone know more about Diabetes Insipidus?

Psychaprn · Mar 17, 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.

Or maybe the information does get in and bombards the diabetic-leaving them to think the hell with it-this disease is going to kill me no matterr what and it will rob me of one organ or limb at a time-I might as well eat whatever I want. We need to remember diabetics can have clinical depression or eating disorders that need tx. too.

one03grad · Mar 17, 2006

Hi everyone

I have been a type 1 diabetic for 12 years and have had a pump for 4. My classmates are always trying to get on me about eating a cookie or anything sweet and i have to try to make them understand that is CHO not just simple sugar.Anyways, has any one heard about the new inhaled insulin that was approved by the FDA to treat type 1 and 2? How exciting. I am going to ask about that to my endocrinologist. Its not going to be available until this summer though and you may have to supplement one or two injections. If the effect controls my BG as well as the pump then i say " BRING IT ON". It would be nice not to carry my "beeper". :lol2:

rn undisclosed name · Mar 17, 2006

yeah, i always thought di was caused by a med like lithium or steroids and was reversible-anyone know more about diabetes insipidus?

i am a nursing student and have been told that some causes are

[color=#333399](1) head trauma/injury, (2) cerebral infection, (3) anything that can cause pituitary gland destruction (hypophysectomy, tumor that grows and obliterates the function, etc...).

[color=#333399]i have not heard of lithium or steroids causing it. i'm not quite sure how that would work because acth is produced from the anterior pituitary and adh is produced from the posterior pituitary. hmmmmm

[color=#333399]

[color=#333399]oh yeah, it is reversible by correcting the cause or administering vasopressin (in an acute situation) or desmopressin (long term use). you can also give thiazide diuretics with or without diabenese. the rationale for that is t[color=#333399]hiazide diuretics and oral hypoglycemic agents potentiate the effects of adh that is already present in the body and makes it more effective. in order to use the thiazide diuretics you need to have part of the posterior lobe and it must be the mild form of di.

[color=#333399]

[color=#333399]i could tell you more but i think i'll stop here.

[color=#333399]

[color=#333399]kelly

grannynurse FNP student · Mar 18, 2006

I have not heard of Lithium or steroids causing it. I'm not quite sure how that would work because ACTH is produced from the anterior pituitary and ADH is produced from the posterior pituitary. Hmmmmm

Steroids cause a rise in one's blood sugars. I don't know how many times I have heard steroids cause diabetes, which they do not.

Grannynurse:balloons:

susannyc · Mar 18, 2006

Lithium use is a factor in Diabetes Insipidus, but doesn't affect the pituitary hormones. Instead, the Lithium acts directly on the kidney to prevent the concentration of urine. Therefore, the urine has the low specific gravity associated with DI, but the pituitary hormone mechanism is intact. The treatment is to D/C the Lithium, and note on the pt's chart that he is not to receive any mood stabilisers containing lithium. The patient also needs to be watched for dehydration. As far as I know, the damage to the kidney is permanent, but I've never seen anyone go into renal failure solely from this if it is caught quickly. Therefore, constant monitoring of patients receiving lithium based mood stabilisers is a necessity.

Elly · Mar 18, 2006

Can I ask what Byetta is ???

RedSox33RN · Mar 18, 2006

I just had to add that while at work the other day (I work as an LNA on a Med/Surg unit), I was commenting about some new flavored glucose tablets I bought (sour apple), and that my 9yo son liked to have one once in a while.

An RN then proceeded to tell me, "What, you want to make the kid diabetic?!" I must say, I was astounded at her lack of knowledge, given that she works with diabetics every day. Why would she think that anyone eating a glucose tablet would CAUSE diabetes? I asked her why she thought that, and her only response is that "glucose is bad for non-diabetics".

HUH??? Mind-boggling!

As a student nurse, I have a lot of other students AND nurses interested in my pump. I like being able to teach them things also, especially since our current unit (with exam on Monday) is on diabetes and respiratory. I did have to bone up on my diabetic medications, since I'm not as familiar with Type 2 meds.

Works2xs · Mar 18, 2006

Pet peeve #: Doctors who constantly remind you that "life style changes" are required. Thanks for the tip, Capt. Obvious. How 'bout taking a microsecond to listen to what my current lifestyle is so that I can have a better chance at identifying changes and an associated regimen that's more likely to work for me.

Pet peeve #: Living with the constant stress regarding BG control and the insidious nature of the damage a lack of control causes. All made worse by the number of calandar months that flip by while waiting for the doctor to realize his standard, one-over-the-world solution, just isn't working.

Now, pump up the frustration level knowing that if he/she would just do a bit of the above "therapeutic communication" you'd have your control issues in hand - "as evidenced by" the fact that when he/she finally did land on the regimen you'd been asking for more than a year, you'd have had that 6.1 hba1c you just got that much earlier.

Pet peeve #: Doc - Stop treating me as though I'm an idiot. If you are just going to dismiss what I'm telling you out of hand, don't ask me the friggin questions in the first place. Better yet, just mail your protocols and scripts to me so I can save us both the time and frustration.

Yeah, I realize compliance issues abound and that patients often shade the truth because they don't want to "get in trouble." I just hate having to be treated like a bonehead because the doc expects it and does precious little to find out otherwise. And yeah, the doc's probably better off "playing the odds" regarding patient compliance issues so that there's less chance of screwing up someone. But none of those facts make my experiences any less frustrating.

grannynurse FNP student · Mar 18, 2006

Has anyone heard of the DAWN Program? If you have, what have you heard. If not, do you want to know about it?

Grannynurse:balloons:

grannynurse FNP student · Mar 18, 2006

Pet peeve #: Doctors who constantly remind you that "life style changes" are required. Thanks for the tip, Capt. Obvious. How 'bout taking a microsecond to listen to what my current lifestyle is so that I can have a better chance at identifying changes and an associated regimen that's more likely to work for me.
Pet peeve #: Living with the constant stress regarding BG control and the insidious nature of the damage a lack of control causes. All made worse by the number of calandar months that flip by while waiting for the doctor to realize his standard, one-over-the-world solution, just isn't working.
Now, pump up the frustration level knowing that if he/she would just do a bit of the above "therapeutic communication" you'd have your control issues in hand - "as evidenced by" the fact that when he/she finally did land on the regimen you'd been asking for more than a year, you'd have had that 6.1 hba1c you just got that much earlier.
Pet peeve #: Doc - Stop treating me as though I'm an idiot. If you are just going to dismiss what I'm telling you out of hand, don't ask me the friggin questions in the first place. Better yet, just mail your protocols and scripts to me so I can save us both the time and frustration.
Yeah, I realize compliance issues abound and that patients often shade the truth because they don't want to "get in trouble." I just hate having to be treated like a bonehead because the doc expects it and does precious little to find out otherwise. And yeah, the doc's probably better off "playing the odds" regarding patient compliance issues so that there's less chance of screwing up someone. But none of those facts make my experiences any less frustrating.

You raise some interesting points. And would it surprise you that the issues you raise concerning doctors, also are issues that many nurses also posses. I spent part of last evening at USF's library and found several articles that address the attitudes and the negative impact they have on diabetics.

Grannynurse:balloons: