Nurses with Diabetes

Specialties Endocrine

Published

My life changed this week. I was diagnosed with Type 2 diabetes. Fasting bs in the 400s :uhoh3: My doctor is wonderful....started on metformin, up to 1000 mg today.

My fasting was 256 this AM...and I am struggling to get it into normal range. BTW, I have had my days off during this. My questions are:

1. Should I return to work with high blood sugars? I noticed I had a headache, felt tired and grumpy the last several shifts I worked before I was diagnosed.

2. How does one manage this while working on a hectic Med/Surg Tele unit, working 7 PM to 7 AM 3 nights/week? :eek:

Thanks in advance for your advice. :bowingpur

I too have joined the ranks. My dad discovered his Type 2 Diabetes at the same age in his life that I have. I'm mirroring his progress, though I don't know that I ever heard him say that he lost the feeling in his feet.

I lost the ability to feel the hot. Still didn't do anything. About 2 or 3 years before that, I noticed the Plastic Wrap feel to the bottoms of my feet as I would get up in the mornings. My fastings were not bad at this time and my Internal Medicine MD is excellent. She was keeping an eye on me. So all told, I've really been a diabetic for about 8 or 9 years, only 3 with treatment. I wonder if I will ever get some of this feeling back in my feet. I've done a little research online, but nothing speaks to that point...it's just that part of it really bothers me.

jen

please check out brain.hastypastry.net/forums go to the peripheral neuropathy forum.....good luck......

p.s. the post prandial bs has been "gold standard" for at least a couple of years......and apparently peripheral neuropathy esp of feet can precede a dx of "frank" diabetes ......good luck

pps research benfotamine/benfotiamine

Specializes in Telemetry/Med Surg.

Another RN recently diagnosed with Type II as well. I need to lose weight...in a major way! I've been on an emotional roller coaster lately in my personal life that I'm not eating right, certainly not 3 meals/day and not good choices either. Arrrggghhh:o

Find an aggressive endo quick! Oral diabetes meds won't touch the BG levels you have. You need insulin, and the sooner the better. Your Hemoglobin A1C could have been 12% or higher. The goal for good control is 6.5% or lower. PO meds can achieve only about a 2 point drop in the A1C. It takes insulin to get the kind of results you need. Your vision will improve when your BG control improves, so don't go out & get new glasses.

In annual checkups, usually only fasting BG is checked. 126 mg/dl is considered diabetes. A Hemoglobin A1C can tell you how good or bad BG control has been over past 2 to 3 months. Many people will have a good fasting BG, but cannot handle a large amount of carbs at one time. So FBG might be under 100, but if A1C is 6% or higher, this means after-meal BG levels have been high enough to push the A1C into the diabetic range.

Lifestyle changes are important, but without insulin, high BG levels can't usually be controlled. You need a combination of long, slow acting insulin (Lantus, Levemir, or NPH, plus rapid acting mealtime insulin (Novolog, Humalog, or Apidra). This does not necessarily mean that you will need insulin in the long term. Many people are able to switch to PO after good BG control is achieved. Your weight loss was due to your body's use of fat for energy since you were unable to use the carbs in your food for energy. Insulin resistance prevented effective use of your own insulin.

I am an RN and a Certified Diabetes Educator, and I work in a hospital based ADA accredited Diabetes Care Center . I also have type 2 diabetes. I hope that you will be able to find an endcrinologist who will be able to help you achieve good control sooner, rather than later. Most PCP's think they are capable of treating type 2 diabetes, but in my experience, they tend to undertreat and take much longer than necessary get good results. Make sure you go to a Board Certified endo.

Good luck with your education session on Friday. I would love to hear from you to see how you are doing.

Thank you so much for the information. My visit went pretty well. She broke it down for me in a way it'll be easier to count what I'll need daily to eat and gave me a check off sheet to keep up with it. She also added to the other meds a couple of others. They are Glucotrol XL, Crestor & an aspirin a day. My triglycerides & LDL were high also. I have lost 5 lbs since last week. Yay! I just got back from the book store, where I bought 3 Diabetic cookbooks so I can find some things to eat so I won't get bored eating the same ole thing the same ole way all the time.

One thing that concerns me that neither she nor the doctor could explain is the ketones in my urine. She said that usually happens with Type 1. But she told me to continue testing my urine each day and if it continues through the next time I go back, they'll investigate it further. Got any ideas why?

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.
Thank you so much for the information. My visit went pretty well. She broke it down for me in a way it'll be easier to count what I'll need daily to eat and gave me a check off sheet to keep up with it. She also added to the other meds a couple of others. They are Glucotrol XL, Crestor & an aspirin a day. My triglycerides & LDL were high also. I have lost 5 lbs since last week. Yay! I just got back from the book store, where I bought 3 Diabetic cookbooks so I can find some things to eat so I won't get bored eating the same ole thing the same ole way all the time.

One thing that concerns me that neither she nor the doctor could explain is the ketones in my urine. She said that usually happens with Type 1. But she told me to continue testing my urine each day and if it continues through the next time I go back, they'll investigate it further. Got any ideas why?

I hope this gets through--it[s my third attempt.

You have urine ketones because your body is burning fat for energy. Happens in type 1 at glucose levels as low as 240, but can happen in type 2 at much higher BG levels--400's - 700's. I'm going to try to see if this will post. I wrote long message and did not go

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

Presence of urine ketones and weight loss indicates BG still very high Your body is burning fat because your insulin is not working well enough to allow you to use glucose from food for energy. Ketones are a byproduct of the incomplete burning of fat for energy. This can lead to DKA, even in type 2 DM if BG and ketone levels in blood are high enough. This is one of the reasons I think you need insulin now and that pills are not enough at this time

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

Glucotrol stimulates release of insulin from the pancreas. XL is a long acting form which can be taken once daily at about the same time everyday. However, as I said before, oral DM meds are not effective in cases where the BG is as high as yours.

If a person has an A1C of 6.5 or 7%, diet and exercise are aften sufficient to control BG. Diet and Oral meds work if A1C is 8.5% or so. When A1C is above 9%, insulin is usually needed--at least temporarily.

Diet can make a dramatic difference in AIC if person's diet was very high in carbs, including sweets, fruit juice, regular soda, and other sugary drinks. That person has a lot that can be cut out to reduce A1C. However, if carb intake was more moderate, diet would not produce such a dramatic drop in A1C. Ask your doctor for AIC result. Or have it done if he did not check it.

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

Even people without DM produce ketones if the amount of carbs in diet is severely reduced or eliminated. Since no carbs are available, the body burns fat and produces ketones. If the amt of carbs is too high, insulin production is stimulated & body uses carbs and stops burning fat. The is the basis of the Atkins Diet. Atkins dieters even use ketostix to check for urine ketones to ensure that carb intake is not high enough to stop ketone production. (Purple is good for these dieters). The resulting state of ketosis has been the medical community's chief criticism of the diet. Atkins held that this state of ketosis was not dangerous because BG levels were not high and the ketosis did not progress to DKA. He does recommend 8 glasses of water daily to help eliminate the ketones.

I know I said above mine has been ranging from 200 to almost 500 range. There have been several times the past week it was like 470-something to 498, but for the most part, it's been around 360-something a couple of hours after eating and around 302-306 fasting. With the ketones, could this mean that it's in the 400s more often than I realize, but just not catching it at that time since I don't check it right after eating or something? When I was first diagnosed three weeks ago today, my HgbA1C was 10.7.

I knew about the ketones with Atkins. Back in nursing school, I went on that diet and on the 7th day, one of my classmates said something about it to my clinical instructor...who just happened to be the one to do all the GU lectures. She blessed me out in front of the class about all the damage I could be doing to my kidneys and I went off that diet that very day and never did it again.

Over the years, my diet has probably been more carbs than protein. I really have a sweet tooth, especially with chooolate. But since finding out I'm diabetic, I haven't had any of those. It's kinda strange, but I haven't even missed or craved them lately. My drink of choice for years has been Diet Coke or coffee with Sweet 'n Low and skim milk and regular soft drinks are too sweet for me. The past three weeks, I've stuck pretty well with eating what's recommended on the ADA website.

When I go back to the NP next month, if there hasn't been any changes, I will request a referral to an endocrinologist. With our insurance, we have to have a referral or it won't pay for specialists. I know of an excellant endocrinologist who sees patients often at the hospital where I work and if I can ever catch her where she seems to have a few seconds, I might run all this by her and see what she says. I'm just not the type person to ask doctors questions about myself while at work. I'd like to see her as a patient if I get that referral.

Thank you for all your info!

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

Don't be shy; talk to her. I have Humana HMO, which often seems to be one of the worst. However when I was dx'd with DM, my PCP referred me to an endo immediately. My A1C was 8%, and after 3 months on metformin, my A1c was 6%. Please fight for yourself and the tx you need.

Blood sugar levels under 200 damage your body. IF YOU ARE 300 FASTING, YOU ARE AT THAT LEVEL OR HIGHER MOST OF THE DAY! Generally when the A1c is under 9%, after meal BG tends to be more of a problem. When the A1C is 9 or higher, BG is high fasting and after meals.

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

FOR SCRN1 I tried to send you a private message today, but your inbox is full. Note stated no more PMs can be accepted until you clear some space.

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

FOR SCRN1: I tried to send PM, but was rejected because inbox is full. No PMs can be accepted until space is cleared.

I don't mean to suggest that your PCP is clueless about DM management and am glad he follows ACE recommendations for target goals. It just frustrates me that so few PCPs recognize the limits of oral med therapy.

Rather than taking 1 to 3 months to get to goal, it may take 6 or more. In fact most internists would follow a similar path for same reason as yours. Also, even when some PCPs suggest insulin, the patient is so against the idea that the PCP will go with orals first to appease the pt.

Specializes in critical care, management, med surg, edu.

I was dx with type 2 just last week with an A1C of 7.7. Of course, I had to check my own fasting & 2hpp just to convince myself of the dx. I've not yet started the metformin, but glad to know that it won't cause hypo-g. That is my biggest immediate fear.

Does anyone use a pda resource to manage diet? Is counting carbs the best way to go?

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