DKA- how often do you see the same ones

[HyperRNRachel]

We have one girl who comes in every 2 months in DKA. NO viens anymore, so now we are restricted to central lines! I honsestly think she does not given herself insulin in order to maintain a VERY low weight- she looks anorexic. And, although, she comes in with n/v (i have never seen her vomit) she always has a negative ct and ultrasound but asks for pain meds! How often do you see the same DKA patients? Does anyone know the name of the condition for DM patients who do not administer insulin in order to control weight?

Rachel

[edmia, BSN, RN]

something like more than 3 visits a year for the same reason should be investigated but it depends on the facility.

That's funny! more than 3? wow, this must be in a private institution.

DKA frequent flyers are many for our ED. I recently had a pt. whose visit count was over 1000, with 88 of them in 2008 already. Most of them uncontrolled diabetes related issues. Very sad.

Thanks for this diabulimia insight, I hadn't heard of it but can identify a couple of our DM pts already.

[hypocaffeinemia, BSN, RN]

I wonder how useful something like monthly HgbA1C monitoring would be as a preventative measure in adolescent/young female diabetics that have shown signs of this.

[NotReady4PrimeTime, RN]

Years ago we had a teenager who would come in several times a year like clockwork. He was a street kid... with loving parents who had finally had enough of his delinquent behavior and had him placed in a group home. That wasn't acceptable to him so he became a chronic eloper. However, he'd manage his diabetes well enough most of the time, except when he was scheduled for a probation office visit or a court appearance. Then he'd turn up in Peds ER with glucoses in the 35-40 (700 oto 800) range, bicarbs in the single digits. We'd tune him up and off he'd go, to return a few months later.

There was a time later on that I floated to the adult medical ICU; I was having coffee with their staff and this young man's name came up. He had turned 18 and was no longer a peds patient; they were seeing him about as often as we had. Eventually I moved away from that city. Then one day about two years ago I was looking at the obits from there on line and there he was. He was 24 years old when he died. Such a waste of what could have been a good life.

I used to work with a nurse who had brittle diabetes. She ate the most inappropriate things! She worked permanent nights and on her second break she'd munch her way through a nacho basket from 7Eleven, then an entire box of frozen fruit juice bars. She never went anywhere without a can of diet Pepsi. One year on Christmas Eve we had a pot-luck and she decided that she'd just give herself a small dose of insulin every so often so that she wouldn't have to deprive herself of all the treats. Test? ANh, she knew how she felt when her sugars were up or down so she'd just go by how she felt. Well, at about 4 am she collapsed, had a seizure and had a glucose of 2.2... They packed her off to the ER and then she went home. Her parting remark was that sh'ed get to be home whenher kids got up for their Christmas gifts after all. She was given an islet cell transplant that was unsuccessful (wonder why?) and then a second one. I don't know that she ever told Dr. S about her real eating patterns. She left our unit after some complaints to the BON about unskilled practice. Why would a health care professional take such risks?