Diet and diabetes--how important?

hypnotic_nurse · Jun 11, 2004

They are crazy.

Gator,SN · Jun 11, 2004

I work in CCU and studies have shown that tight glucose control improves mortality in pts, diabetic or not. IDDM causes damage in the body when uncontrolled and I think that this is a dangerous practice.

No doubt I'll be seeing these patients in my unit over and over. How sad!

Gator

Hellllllo Nurse, BSN, RN · Jun 11, 2004

I worked through an agency earlier this week at a LTC where the powers that be decided that they were going to do away with ADA diets because they don't want to restrict what the residents eat. Well, I can understand not wanting to interfere with a person's choice in food, but isn't diet a pretty important measure for controlling blood sugar?
One resident had an ac CBG of 155, which according to her sliding scale meant no insulin (no coverage until 200!). A few hours later, the hs CBG was 408. It just seems to me that this wide variation in levels is very unhealthy.
Has anyone else dealt with a facility that does not follow any ADA diets?

This is the dumbest thing I've ever heard. No doubt an administrator without a medical background thought this up.

The patients have doctor's orders for their diets. Does the facility plan to disregard the orders?

I hope they have a good lawyer for when the families start suing when the pts began having complications and worsening of other conditions (heart disease, vessel disease, etc) r/t out of control blood sugars.

leslie :-D · Jun 11, 2004

at the last facility where i worked, the rd recommended dcing all of the ada diets stating that qid fingersticks and ss insulin would suffice. i asked a couple of the mds about it and both told me that this indeed, is a new school of thought. it is a concept that i find extremely difficult to adapt to in most situations. but thought i would relay one registered dietitian's teachings.

leslie

Long Term Care Columnist / Guide · Jun 11, 2004

Yes, I agree with you all in principle........but there is also a thing called residents' rights, and those include the right to be noncompliant with the treatment plan, just like patients outside the nursing home setting. We used to deal with this issue all the time when I was an LTC care manager, and the state ALWAYS comes down on the side of the resident, with good reason. You don't give up your rights as a citizen just because you move into a nursing facility; all the staff can do is educate and encourage you.

This doesn't mean that the staff and administrators should give up and do away with all dietary restrictions, especially when they are ordered by the physician; but if someone wants to eat that Krispy Kreme or snarf down that sodium-laden popcorn, they cannot be prevented from doing so. I can't count the number of times I've seen well-intentioned aides take a dessert away from a resident, or refuse to serve them, "because they're diabetic and they shouldn't eat sweets". That's not the aide's decision. That's not the doctor's decision. It's the resident's decision, and even if it's not in their best interests, they have the right to make it.

Just my .02 worth.

Gompers, BSN, RN · Jun 11, 2004

Yes, I agree with you all in principle........but there is also a thing called residents' rights, and those include the right to be noncompliant with the treatment plan, just like patients outside the nursing home setting. We used to deal with this issue all the time when I was an LTC care manager, and the state ALWAYS comes down on the side of the resident, with good reason. You don't give up your rights as a citizen just because you move into a nursing facility; all the staff can do is educate and encourage you.
This doesn't mean that the staff and administrators should give up and do away with all dietary restrictions, especially when they are ordered by the physician; but if someone wants to eat that Krispy Kreme or snarf down that sodium-laden popcorn, they cannot be prevented from doing so. I can't count the number of times I've seen well-intentioned aides take a dessert away from a resident, or refuse to serve them, "because they're diabetic and they shouldn't eat sweets". That's not the aide's decision. That's not the doctor's decision. It's the resident's decision, and even if it's not in their best interests, they have the right to make it.
Just my .02 worth.

Excellent post! I totally agree - it's really up to the patient. I do understand that the facility deciding to throw out recommended dietary guidelines is a whole other issue, because they're making decisions for a lot of people. But as far as individual diet plans, I agree that the patient has the right to decide. My grandmother, for instance, has type 2 diabetes. She knows that if she continues to eat cake and drink soda like she always has, that she's basically going to die a whole lot sooner than later. But you know, for about a month she tried to be "good" and I swear, she was so miserable. She's so happy as long as she has her sweets. My grandpa died a few years ago, and she's been pretty lonely without him. So why is it more important for her to follow a strict diet and live ten years longer than if she just enjoys her life now and makes her own decisions?

Blackcat99 · Jun 12, 2004

:) In the "old days" we would all freak out if a diabetic was found eating a chocolate candy bar. Nowadays, it's not unusual in LTC to find an insulin dependent diabetic eating chocolate bars. I remember one lady in particular who was always eating sweets that her family had brought in for her.

Angela Mac · Jun 19, 2004

Yeah- some LTC facilities have done away with the ADA diets, and have changed to NCS (no concentrated sweets) or calorie counts. No diet is better than that which is outlined by the American Diabetes Association. In fact, I am not diabetic, but am considering their diet for a healthier lifestyle, minus the snacks, in my case.

movealong · Jun 20, 2004

It's been my opinion for some time that following a diabetic diet must be one of the hardest things to do, mainly because it is ongoing, never ends. So I can understand the occasional deviation, "cheating" on the diet from time to time.

I live in the world of reality. BUT, a diabetic just cannot do this on a regular basis with suffering the ill effects down the road. Those that do not follow a diet with any sense of regularity are in denial about their disease. I will not reinforce their denial. While it is their choice, I will remind them of the consequences of their choices.

ADA diets have been around forever. Lots now follow a carb counting diet, which is fine. Avoiding concentrated sweets, well yes, that's good, but it is generally speaking not good enough. It drives me crazy when I speak to patients and they tell me this was the only diet advice they received from their md. And they are having problems with their blood glucose readings and their HbA1C levels. I always tell them to ask for a referral to a dietician. It blows me away if they have never seen one. In my mind, at the time of diagnosis, they should have received this referral, and been sent to diabetic education classses.

I push them to make appointments for their foot care. I tell them to remove their socks and shoes for even their routine visits with their md. A doctor should be inspecting those feet at every visit.