"I need to eat, I'm a diabetic!"

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I get a little tired of patients and their visitors demanding food because "I'm a diabetic". Last time that line was used on me by your typical overweight type 2 diabetic, I took his blood sugar. It was over 200 of course. I told him that, you only HAVE to eat when your blood sugar is low, and no, I'm not getting you a sandwich, your blood sugar is actually high. This was an ER patient with a minor complaint. :banghead:

I agree. I think my frustration with many (not all) diabetics is the lack of personal responsibility. Such as the patient in question, in my original post. He reeked of cigarettes, came to the ER for the sniffles, was getting impatient because of the wait. Then he demanded food, saying he was a diabetic.

I asked him what his sugar was because, of course I was concerned that maybe he was dropping. He said he had no idea. So I took his blood sugar and it was over 200. He actually wasn't my patient at the time, but we do a lot of teamwork in the ER.

But you compliant, responsible diabetics out there, please don't take this thread personally! We love and care about you, and sympathize with your struggles!

We are talking about a sandwich here, not a full on three course meal. Clearly, this patient needed a great deal more support than the "sniffles".

People don't usually come to the hospital for the food. However, there would be red flags all over the place on this patient. And I think I would have discussion with the primary nurse regarding social work and the psych/social needs of this patient.

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Specializes in ER.

In the ER we are so overwhelmed with psych and social needs it's not even funny. We simply do not have time to deal with it.

Our system has encouraged socially challenged pts to seek care in ERs for minor things, expecting immediate service, then they get a survey. What it doesn't encourage is self responsibility.

In the ER we nurses are pushed to get pts in and out quickly. We don't have social workers.

We are not miracle workers...

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Specializes in Nurse Leader specializing in Labor & Delivery.
Our system has encouraged socially challenged pts to seek care in ERs for minor things, expecting immediate service, then they get a survey. What it doesn't encourage is self responsibility..

It's definitely one of the most challenging parts of my job, I will say (working predominantly with the ininsured, homeless, mentally ill, drug addicted - our facility is a "safety net" hospital and so we see a much higher proportion of that demographic than other facilities). I have to say, I could never in a million years be an ED nurse, for that reason. I see so many people misusing the ED - calling an ambulance and going in for nausea/vomiting x 1 day, lady partsl infections, ingrown toenails, "I think I'm pregnant".

I wish the EDs could have a person who sits out in the lobby to triage the people coming in, and those who are not actually appropriate for the ED, they establish them with a PCP and set up an appointment for them with the PCP within the next 7 days.

So much of what I see that frustrates me is cultural - it's how it's always been done, and it's all they know. It's next to impossible to change 3+ generations of ingrained behaviors.

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i love how the same people in here arguing about crap is the same people saying "bullying dont exist".

yeah okay kids.

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Specializes in Pediatrics, Emergency, Trauma.
It's definitely one of the most challenging parts of my job, I will say (working predominantly with the ininsured, homeless, mentally ill, drug addicted - our facility is a "safety net" hospital and so we see a much higher proportion of that demographic than other facilities). I have to say, I could never in a million years be an ED nurse, for that reason. I see so many people misusing the ED - calling an ambulance and going in for nausea/vomiting x 1 day, lady partsl infections, ingrown toenails, "I think I'm pregnant".

I wish the EDs could have a person who sits out in the lobby to triage the people coming in, and those who are not actually appropriate for the ED, they establish them with a PCP and set up an appointment for them with the PCP within the next 7 days.

So much of what I see that frustrates me is cultural - it's how it's always been done, and it's all they know. It's next to impossible to change 3+ generations of ingrained behaviors.

They are called nurse navigators; they have them in my area; they help find those who are in the "safety net" area, and will help with pts who need assistance with psychosocial and health issues; they are also referred to Disease management nurses. :yes:

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He's going to be hungry. Polyphagia is a symptom of hyperglycemia. You don't have to be condescending. As a type 1, I've told a nurse in the hospital that I was hungry. She commented the same, rudely, to which I told her: "Are you diabetic? No? Ok then. Iknow my blood sugar is 300. I'm not going to eat, but understand the incessant hunger and thirst I feel and try to not be condescending."

I understand polyphagia. Whenever I tell my doctors that I want to eat everything in sight and it is not like the "normal" feelings of true hunger that I remember from my past, they just fall back on whatever latest test shows that I am supposedly not diabetic. While I can see the humor in the first post, I can also empathize with those who find this subject not humorous. It is not a pleasant condition.

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Specializes in Nurse Leader specializing in Labor & Delivery.
i love how the same people in here arguing about crap is the same people saying "bullying dont exist".

yeah okay kids.

What are you talking about?

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In the ER we are so overwhelmed with psych and social needs it's not even funny. We simply do not have time to deal with it.

Our system has encouraged socially challenged pts to seek care in ERs for minor things, expecting immediate service, then they get a survey. What it doesn't encourage is self responsibility.

In the ER we nurses are pushed to get pts in and out quickly. We don't have social workers.

We are not miracle workers...

But your facility must have a social worker. And if you are charting that patient had "no idea" what their blood sugar is, that they were seemingly non-compliant, one should then document what was done about it.

Because this demographic may not get surveys, but they can and do have uncontrolled diabeties, which needs to be addressed--ie: education on (and documentation) to whatever assistance information you can give them.

Which could mean you will not ever have to be "spoken to" or worse by a "I told nurse Emergent that I was hungry, and she said my blood sugar was too high to have something to eat" when they come back with a low critical blood sugar.

And then the bus backs over you......

I get the "get em in, get em out" stuff-- but cover yourself in the process-and ALWAYS ask..."hey practitioner, pt in treatment room 7 has a FBS of 200, but is hungry and asking to eat. Thoughts?" And then if they feel the patient doesn't need food--welp then that is on them, and then YOU can document "MD/NP/PA aware" and not have it fall on you.

And a good way to bring about policy change for what to do with those patients who are socially/psych challenged so that it doesn't come back and bite anyone.

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In an ideal world, perhaps. But that's not what I'm being taught in first quarter nursing school. My instructors are telling us that is is 100% about addressing the patients needs, not ours. This is pretty hard. I didn't realize that sainthood was a prerequisite for the RN credential but we appear to be held to a very high standard that includes not requiring or expecting any compassion or other meeting of our needs from patients. That's TOUGH but can anyone who's out there working as a nurse tell me it's different?

I think it's different, I'm if starving or my bladders about to explode I don't care what's going on I need to meet those needs. No matter what's going on it takes 5 minutes to pee and eat a granola bar and it makes all the difference in the world. Your patient's can wait 5 minutes, if another nurse needed your help for 5 mins you would take that time so how is it different? All your patient's are ALWAYS going to need something, even if everything is done for the moment if you really wanted to go above and beyond you'd be running every second of every shift, you could shave a male pt's face, clean under their nails, scrub their dentures, ambulate them, sit and listen to EVERY single long boring story, the list goes on and on. You could make yourself crazy! You need to keep you sane if not for yourself how do you expect to take care of patient's if you're cranky and passing out from low blood sugar?

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It's definitely one of the most challenging parts of my job, I will say (working predominantly with the ininsured, homeless, mentally ill, drug addicted - our facility is a "safety net" hospital and so we see a much higher proportion of that demographic than other facilities). I have to say, I could never in a million years be an ED nurse, for that reason. I see so many people misusing the ED - calling an ambulance and going in for nausea/vomiting x 1 day, lady partsl infections, ingrown toenails, "I think I'm pregnant".

I wish the EDs could have a person who sits out in the lobby to triage the people coming in, and those who are not actually appropriate for the ED, they establish them with a PCP and set up an appointment for them with the PCP within the next 7 days.

So much of what I see that frustrates me is cultural - it's how it's always been done, and it's all they know. It's next to impossible to change 3+ generations of ingrained behaviors.

IT is because it is the only place to receive care, that you can not be turned away from. Even if you can not afford it. I think if they really get the affordable health care act, really affordable, then they need to change the rules so that ONLY emergency care happens in the ER and other types of issues are sent elsewhere. This to lower cost. But it would take take and re educate the public at large.

Plus, we have become a society that when we want something, we are use to getting it NOW. Very little waiting. Microwaves, cars, cell phones, internet. it's all NOW. Add mental illness in this equation, and society has some major issues. It isn't helping that some people have learned to throw their butt around, and act ugly to get what they want. Their kids see this, and they learn to copy this behavior. Because they have learned that this behavior gets them what they want. The next generation no longer realizes it is a 'game' and actually believe that is how things work. Sad, sad

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Specializes in Pediatric Hematology/Oncology.
In an ideal world, perhaps. But that's not what I'm being taught in first quarter nursing school. My instructors are telling us that is is 100% about addressing the patients needs, not ours. This is pretty hard. I didn't realize that sainthood was a prerequisite for the RN credential but we appear to be held to a very high standard that includes not requiring or expecting any compassion or other meeting of our needs from patients. That's TOUGH but can anyone who's out there working as a nurse tell me it's different?

I don't quite think that it's that extreme. We had some instructors who seemed to be on that extreme end of the spectrum. I believe there will be some days where you turn around and it's 7 hrs since you took report and then something critical happens and before you know it, you're now giving report. Then, on the way home, halfway through the drive, you realize that you didn't eat at all. And, you can't believe your bladder doesn't ache the way you would expect it since you didn't have a pee break for the past 9 hours (then you chug extra cranberry juice cuz you know that's the perfect storm for a UTI). I do this in my current job (and it is in no way related to nursing but there can be some seriously busy days). I don't think there'll ever be a day where you're choosing between your break and a pt's critical need. You're just going to make the right choice. You won't feel the sacrifice (well, maybe a little but just for a split second).

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Ive been Type2 for 15 years now. Aside from the very beginning my blood sugars seldom ever go over 150. Id flip a freakin nutty if they did. I do everything I can to keep my A1c less than 5 if possible. Day to day they run from 48 to 90 Anything lower and I get the sweating, the shakes and extreme nauseousness. The last time it got over 200 I felt so terrible, hot, shaky and so hungry I couldnt stand it.

Be nice...to yourselves and each other, we're ALL different

:blink:

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