"my mom has diabetes, but why is her blood sugar so unstable?"

[rnto?]

Sometimes I feel like I'm just banging my head against a wall trying to educate some people. Mom's blood sugar was 366 this afternoon. Her metformin and glucophage are on hold because she was bottoming out into the 40's. "but her blood sugar was well controlled at home" says the daughter. "Well," says the nurse, "alot of things alter your blood sugar. Any change in her health will also cause her blood sugar readings to change. She has an infection in her bladder, and she just had a stroke. also, being in the hospital increases stress, yada yada yada." Daughter, "Well, I want doctor called RIGHT NOW because something has to be done about her sugar. it was always 90 at home. and she was really low the other day" **headdesk** /rant

[wooh, BSN, RN]

Ugh, the "I want the doctor called right NOW" people. Probably my favorite flavor of annoying family member.

[kerric511]

lol, yeah, gotta love "those" I've gotten plenty.

I swear one day someone is going to catch me in an off mood and I'm going to fold my arms, and nod my head like I dream of Jeanie.

I almost did it the other night to...

[nursej22, MSN, RN]

Don't they seem to come in groups, too? One week every family is "I want to call the doctor called now!: high BS, constipation, wants a private room, don't wake mama up at night, cont. pulse ox alarm is too loud, BP too high or too low, MD rounded before family arrived, etc.

This week our "special" is snarky patients: food is bad, nurses are stupid, nurses are bossy, why can't you wheel me outside so I can see my husband while he's smoking, it's too hot, its too cold, the TV is at a bad angle, I need enough chairs for all twelve of my visitors.

[truern]

I don't get the attitude. As her nurse I *would* call the MD "right now" for a BG of 366 with no orders to correct it. Am I missing something?!?

Yes, being stressed can raise it...yes, infection can raise it. But we certainly don't want to leave it raised.

[onetiredmomma]

If there is a sliding scale, there would be no reason for the op to call the md

[RedhairedNurse, BSN, RN]

I don't get the attitude. As her nurse I *would* call the MD "right now" for a BG of 366 with no orders to correct it. Am I missing something?!?

Yes, being stressed can raise it...yes, infection can raise it. But we certainly don't want to leave it raised.

Good point !! Anything > 350 is notify physican where I work.

[canoehead, BSN, RN]

For 366 I'd call the doc anyway.

But for the call the doc NOW people have them make a list of their concerns before you do it so everything is covered. EVERYTHING. So that you don't end up calling again in 30 minutes. Then call the doc and tell them you have a list, and need the physicians official response. Go throught the whole list with them and write down each response on that little piece of paper you brought with you. Make sure you are calling the doc from a private location so you can coach them into an answer you can live with, (no orders to go out to smoke with staff Q1H) Then write any orders applicable in the chart. Then go back to the family and got through each item, and possibly feel some satisfaction that the doc's response is the same on you gave them 5 times before. After that you can go at least 8 hours saying "we'll write that on your list so the next time I call the doc I'll ask." Repeat prn.

Much easier on you than having the family bombard the doc when he comes through the door, because he may write orders that you don't have the time to carry out, or may forget to tell you something ("the doctor said you would...."). If you call with a list most docs will understand you've just saved them some time and energy by being a diplomatic go-between. Ususally the second list is much shorter too.

[Virgo_RN, BSN, RN]

We call the MD for CBGs >300 per protocol. Usually they'll just order an increased dose of the SS insulin they'd already be getting. Since I work swing, some of the docs on call don't do much more than that, punting it to the doc who will actually round on the patient and see them in person in the morning, while a few will make changes to the overall regimen.

For family members that demand "something be done right now", I'll just explain something like "We're going to give her an extra dose of insulin tonight, just to get this blood sugar down, and the doctor who will see her tomorrow, the one that knows her, will take a look at things and make whatever changes they think are needed. But for tonight, we're covered."....or something to that effect. They usually accept that. I rarely have family members that demand I do more than that. If they try to push, I just explain calmly but firmly that the docs on call for evening are for emergencies, and this doesn't fit the definition of an emergency.