Experiences with Diabetic Patients

GrnHonu99, RN · Oct 2, 2005

Hi,
I'm just wondering if anyone wouldn't sharing their experiences dealing with diabetic patients. What were the patients' perception of health? How did their experiences affect you as a nurse?
or
You yourself, have diabetes, so how do you personal experience help / hinder your role as the health care provider?

compliance is one of the biggest concerns for diabetics of all types. I have had pts. that have done a wonderful job contolling their disease and I have had pts. that have not. I took care of a young lady (29) that had type I diabtes for 13 years and was completely non compliant. She is in and out of the hospital and comes in twice a week for dialysis, the last time she came in they removed 13 lbs of liquid from her body. She needs a new kidney, however, due to her noncompliance it is unlikely she will ever recieve one. Her MD had given her only a few more years at best and if she misses her dialysis she will have even less time than that. She never had children or got married and slept every night with a cabbage patch doll. It was very sad.

On the flip side my grandmother, a diabetic also controlled her diabetes through diet and exercise and lived to be near 90 with no complications from the disease, I believe she died from plain old age, or atleast the MDs couldn't give us a difinitive diagnosis, but it wasn't related to her diabetes.

Hope this is what you had in mind. :)

Eilana · Oct 3, 2005

compliance is one of the biggest concerns for diabetics of all types. I have had pts. that have done a wonderful job contolling their disease and I have had pts. that have not. ...
On the flip side my grandmother, a diabetic also controlled her diabetes through diet and exercise and lived to be near 90 with no complications from the disease,

I hope you don't mind me asking, was your grandmother's compliance due in part of her diabetes ... (ie, she was afraid of the secondary effects that stem from diabetes). Some pts are compliant simply because "my doctor said so." Others are truly afraid of dying or the complications involved.

Hope this is what you had in mind.

I'm just trying to understand diabetes from the standpoint that people who have diabetes. How does it affect their daily lives? How has their perspective on health changed?

GrnHonu99, RN · Oct 4, 2005

I hope you don't mind me asking, was your grandmother's compliance due in part of her diabetes ... (ie, she was afraid of the secondary effects that stem from diabetes). Some pts are compliant simply because "my doctor said so." Others are truly afraid of dying or the complications involved.
I'm just trying to understand diabetes from the standpoint that people who have diabetes. How does it affect their daily lives? How has their perspective on health changed?

Well, that is very hard to say, my grandmother was a traditional japanese lady...she never really talked about it. If I had to guess in the beginning it was because the MD said so, she was very subservant. But as a child I remember her taking insulin but as I got older I remember her only having to control it by diet and exersize. So if I had to guess again in the end I assume she was compliant bc she didnt like taking the insulin...i dont even know if diabetics once their on insulin can stip and control it by diet...hmm..maybe its my faulty memory, my mom swears that she always controller her diabetes through diet and exersize...who knows...

I just wrote a paper for my community nursing class about diabetes...I talk about two econmonic and one social factor, namely familly support regarding compliance with diet and exersize regimens..if you would like to read it, PM me and ill forward it to you>

June55Baby · Oct 4, 2005

I was diagnosed with Type 1 diabetes at the age of 30. As a nurse, I was keenly aware of the ravages of that awful disease. I cared for patients on dialysis, with amputations, and that were blind and had had heart attacks and strokes due to diabetes. I decided that I would do all in my power to avoid those complications.

Now it's 20 years later. I have been controlling my diabetes with an Insulin Pump for over 11 years. I check blood sugars at a minimum of 4 times each day and make sure I see my endocrinologist, retinologist and other specialists as recommended. Currently, the only complication of diabetes (if it's even related to diabetes) is a diagnosis of mild hypertension, which I treat with an ACE-I. I have never been hospitalized had to go to the ER or even gone to the doctor (outside of my scheduled appointments) for diabetes related conditions.

I am not perfect and I am not always perfectly compliant with my diabetes care. Sometimes neglecting to check blood sugars and eating whatever I want and I hate to exercise, but one thought of complications snaps me back into compliance. Although I work as a team with my doctors and other diabetes specialists, I am ultimately responsible for my health.

Diabetes is a VERY expensive disease. I am blessed to have WONDERFUL health insurance and am out of pocket only a minimal amount. I often worry about how I could afford to pay for diabetes supplies if I lost my health insurance or what I will do when I have to go on Medicare.

I also worry about how I will care for myself in my old age. How long will I be able to monitor my blood sugar by myself? An insulin pump requires alot of attention; so how long will I be able to continue pump therapy? What does the future hold for me?

Diabetes is NEVER off of my mind. It is my waking thought and the last thought before sleep. When I go anywhere or do anything I have to be aware of the potential of low blood sugar and be prepared to treat as needed OR be ready to treat if blood sugars are too high. I always have to be prepared. Extra insulin, extra pump sets, glucose tablets, Carb counting books all the trappings of diabetes care.

As a nurse, I am amazed (and appalled) by patients who do not take care of themselves. Then I have to remember, most do not have the medical knowledge that I have and many do not have the resources that I am blessed to have to pay for the needed supplies.

I have been asked to become a Diabetes Educator, but have always said no. I have to live with the disease every moment of my life and I don't want to work with it everyday as well.

This is probably much more than you wanted to know, but I hope it helps answer your questions.

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 4, 2005

I was diagnosed with Type 1 diabetes at the age of 30. As a nurse, I was keenly aware of the ravages of that awful disease. I cared for patients on dialysis, with amputations, and that were blind and had had heart attacks and strokes due to diabetes. I decided that I would do all in my power to avoid those complications.
Now it's 20 years later. I have been controlling my diabetes with an Insulin Pump for over 11 years. I check blood sugars at a minimum of 4 times each day and make sure I see my endocrinologist, retinologist and other specialists as recommended. Currently, the only complication of diabetes (if it's even related to diabetes) is a diagnosis of mild hypertension, which I treat with an ACE-I. I have never been hospitalized had to go to the ER or even gone to the doctor (outside of my scheduled appointments) for diabetes related conditions.
I am not perfect and I am not always perfectly compliant with my diabetes care. Sometimes neglecting to check blood sugars and eating whatever I want and I hate to exercise, but one thought of complications snaps me back into compliance. Although I work as a team with my doctors and other diabetes specialists, I am ultimately responsible for my health.
Diabetes is a VERY expensive disease. I am blessed to have WONDERFUL health insurance and am out of pocket only a minimal amount. I often worry about how I could afford to pay for diabetes supplies if I lost my health insurance or what I will do when I have to go on Medicare.
I also worry about how I will care for myself in my old age. How long will I be able to monitor my blood sugar by myself? An insulin pump requires alot of attention; so how long will I be able to continue pump therapy? What does the future hold for me?
Diabetes is NEVER off of my mind. It is my waking thought and the last thought before sleep. When I go anywhere or do anything I have to be aware of the potential of low blood sugar and be prepared to treat as needed OR be ready to treat if blood sugars are too high. I always have to be prepared. Extra insulin, extra pump sets, glucose tablets, Carb counting books all the trappings of diabetes care.
As a nurse, I am amazed (and appalled) by patients who do not take care of themselves. Then I have to remember, most do not have the medical knowledge that I have and many do not have the resources that I am blessed to have to pay for the needed supplies.
I have been asked to become a Diabetes Educator, but have always said no. I have to live with the disease every moment of my life and I don't want to work with it everyday as well.
This is probably much more than you wanted to know, but I hope it helps answer your questions.

That was an excellent response! I want you to be a diabetes educator too, lol! To the OP, denial and financial status seem to affect diabetics more than other folks seem to realize. It's cheaper to buy a box of debbie cakes than it is to buy fruit. A lot of them that I know have their eating habits so ingrained in them that they refuse to change, stating that they've been that way all their life and changing now won't help. Diabetes is a big concern in my state (SC). I routinely interact with pt's who are diabetic and have multiple comorbidities and they just don't seem to care. They have resigned themselves to the idea that diabetes=death, and nothing they do will stop that.

rogramjet · Oct 4, 2005

I have had Type 2 diabetes for 7 years, and have worked in Diabetes Education for the last year. 95% of diabetes care is self care. I learned really quickly that I can't save them all. There are some pateints who are not going to be compliant no matter what I tell them, it gets rather frustrating at times. I have a patient who has an A1c of 17%, (avg BG over 550 for 3 months) and she throws her meds away because they make her gain weight. On the other hand I had a gestational diabetic who had to go on insulin for the last three weeks of her pregnancy, and she had a severe aversion to needles. I got a call from her the other day and she has lost 65# since having the baby, and has totally changed her lifestyle so she never has to go back on insulin. What it comes down to is that the patient has to want to change. If not there really is nothing you can do.

It is kind of funny working in a small town, though. My patients are constantly checking up on me. I have one who rides the bus into town and she looks to make sure my car is at the YMCA every morning. I have others that actually go to the Y in the mornings now and on the rare occasion that I don't go, and they do, God help me. I'm almost afraid to go to the grocery store anymore, because they are likely to see me putting sopmething into the cart that I shouldn't have, even if it is for the kids.

Eilana · Oct 4, 2005

I know that one of the most important thing to changing a health behaviour is for the pt to want to change. Diabetes often requires many lifestyle changes on the part of the client with alterations in diet, exercise, ADL etc (if anybody wants to elaborate on this feel free to do so). Although there are many resources and support groups out there, do you think that we, as health professionals are meeting the needs of diabetic pts?

bsugaRN2b · Oct 6, 2005

I was diagnosed with diabetes at the age of 6, and I'm now going on 20 (Type 1). I did MDI for almost 8 years, and I'm now on insulin pump therapy, which I've been doing for about 6 years now, which I love...never, NEVER going back to injections. I usually check blood sugars at least 8x/day, but it usually runs around 10-12x when all is said and done, quite frankly, I think it's worth it, and I have the confidence of knowing 9 times out of 10, the numbers will be in range...as of now, no complications...

I'm compliant now, but I've gotta say that it wasn't always that way - I've been through about every variation (creative and not so much) of denial in the book, diet, exercise, testing blood sugars, you name it, so I can definitely understand where people are coming from when they aren't compliant. I don't approve of it, but I do understand...for some people, being scared into complying by complications doesn't cut it (especially for teenagers) - the way they look at it, they figure they're going to die anyway, as awful as it sounds, but I know people where that's been the case...

As a nurse, I am amazed (and appalled) by patients who do not take care of themselves. Then I have to remember, most do not have the medical knowledge that I have and many do not have the resources that I am blessed to have to pay for the needed supplies.

This along with the fact that sometimes, they don't have the appropriate "role model" - if you have an endo who always looks down on you and never encourages you, then I don't blame the patient for not taking care of themselves, as they don't have the appropriate encouragement to want to change - which brings me to that, whoever said this, I agree - the patient has to want to change, an endo can't make them change. And yes, it is frustrating to have a patient who won't do the right thing - I'm not an RN-CDE yet, but I have been a diabetes camp counselor, and you do get kids who come in and are like, "When I go home, I won't be testing my blood sugars...", and we counselors and educators are nothing short of terrified to let them go...so yes, that is very true...

Although there are many resources and support groups out there, do you think that we, as health professionals are meeting the needs of diabetic pts?

To answer this question - in the near 15 years I've been diabetic, I've learned that it's really a gift that a GOOD endocrinologist has that makes them so awesome - right now, I have a NP diabetes educator who has had diabetes herself for 30+ years, and she has literally made all the difference (as well as determining my career choice - studying to be a nurse and diabetes educator, lol!) Not that I'm saying that the endo I had before was horrible or anything (she was great), but seeing eye-to-eye from another person with diabetes is priceless - I'm all for having more CDE's/endocrinologists with diabetes! :)

I found the following list online - humorous, but very true down to the last word:

The Top Ten Things Every Endocrinologist/CDE Should Know:

1. The last month of readings hold no clues to what the final A1c will reveal. (Evidenced by myself, it seems that when I run numbers in the 200's, my A1c turns out 7's - numbers in the hundred's, it runs in the 8's...)

2. To be liked by your patients - NEVER scold them about what they eat. We're not stupid, nor are we super-human.

3. Pumping is the Ivy League school of diabetes care (elite). Don't tell your type 1 (or type 2) patients it won't work for them, but make sure they know it will take work.

4. Some individuals will never achieve A1c's under 7 - this doesn't represent a character flaw. They are trying their hardest...

5. Every good thing takes (lots of) time and money. (Such as a cure...)

6. Type 1 and Type 2's are very different. (Duhh, but some endos have not yet grasped this concept)

7. If you tell your young adult patient not to do something because they have diabetes, it is strongly likely that they'll do it...

8. Overeating on hypos are a major source of weight gain.

9. Chocolate should be on everyone's meal plan - its antioxidant, antidepressant, and medical benefits yet undiscovered outweigh the sugar/fat disadvantages.

10. Some people are destined for complications; other people will live till 80 and not get any. It's all in the genes that gave you diabetes in the first place.

Ok, I think I got everything, but if you want, feel free to ask more questions!

~Adria

cep77 · Oct 6, 2005

My uncle is one of the worst cases here in east Texas as far as diabetes is concerned. He is half blind and has already had a kidney transplant that failed after a year (long story), and now with in the past month he has had 2 bypasses to try to save his leg. He is on the last resort, peritoneal dialysis at home and is only going down-hill. The real sad thing is that he is only 42 years old or shall I say young. I have been trying to help my grandmother as things have been getting worse. It's hard, but I really don't think that he has been taking care of himself like he should have in the past (even after the kidney transplant failure)...

sjb2005 · Oct 6, 2005

I was diagnosed with Type 1 diabetes at the age of 30. As a nurse, I was keenly aware of the ravages of that awful disease. I cared for patients on dialysis, with amputations, and that were blind and had had heart attacks and strokes due to diabetes. I decided that I would do all in my power to avoid those complications.
Now it's 20 years later. I have been controlling my diabetes with an Insulin Pump for over 11 years. I check blood sugars at a minimum of 4 times each day and make sure I see my endocrinologist, retinologist and other specialists as recommended. Currently, the only complication of diabetes (if it's even related to diabetes) is a diagnosis of mild hypertension, which I treat with an ACE-I. I have never been hospitalized had to go to the ER or even gone to the doctor (outside of my scheduled appointments) for diabetes related conditions.
I am not perfect and I am not always perfectly compliant with my diabetes care. Sometimes neglecting to check blood sugars and eating whatever I want and I hate to exercise, but one thought of complications snaps me back into compliance. Although I work as a team with my doctors and other diabetes specialists, I am ultimately responsible for my health.
Diabetes is a VERY expensive disease. I am blessed to have WONDERFUL health insurance and am out of pocket only a minimal amount. I often worry about how I could afford to pay for diabetes supplies if I lost my health insurance or what I will do when I have to go on Medicare.
I also worry about how I will care for myself in my old age. How long will I be able to monitor my blood sugar by myself? An insulin pump requires alot of attention; so how long will I be able to continue pump therapy? What does the future hold for me?
Diabetes is NEVER off of my mind. It is my waking thought and the last thought before sleep. When I go anywhere or do anything I have to be aware of the potential of low blood sugar and be prepared to treat as needed OR be ready to treat if blood sugars are too high. I always have to be prepared. Extra insulin, extra pump sets, glucose tablets, Carb counting books all the trappings of diabetes care.
As a nurse, I am amazed (and appalled) by patients who do not take care of themselves. Then I have to remember, most do not have the medical knowledge that I have and many do not have the resources that I am blessed to have to pay for the needed supplies.
I have been asked to become a Diabetes Educator, but have always said no. I have to live with the disease every moment of my life and I don't want to work with it everyday as well.
This is probably much more than you wanted to know, but I hope it helps answer your questions.

Almost a DITTO story for me. I was diagnosed with Type I at 26. By 28, I had a pump. I think the pump helps me a great deal keep on track and be a an effective nurse.

My dad was diagnosed with Type 2 shortly after my diagnosis. His blood sugars ranged around 200 average. He went down hill fast after dialysis started and amputations to his toes/foot. He died at age 62.

I have been hospitalized twice with DKA and other than some HTN, all is good.

My son was diagnosed on his 14th b-day. He is 18 now and has been using a pump for about 1 year or so. He is not overweight but he has already started on HTN meds.

My belief is that the successful outcomes when living with any type of diabetes has many factors. Hereditary, age, metabolism, activity, education, motivation and health insurance all play a role.

Of course, I have been told by my doctors that even with tight control, adverse effects of diabetes can still happen. It's the luck of the draw to some extent. If I could possibly end up on dialysis or with an amputation regardless of how well I keep my blood sugars under control, it makes it somewhat hopelessless.

Sometimes I joke with people. It's a little sick, but I start hopping around on one foot. I tell them I'm practicing for my amputation. Humor helps. But don't get me wrong. I am doing almost everything I can to put off the inevitable for as long as possible.

Eilana · Oct 6, 2005

There is a lot information about diabetes like diet, glucose monitoring, support groups, treatments etc ... what do you think is the biggest misconception about diabetes (from people who do have diabetes and from the people who don't)?