"Real World" diabetes management?

[davidsgirl]

My husband is a RN and I am a nursing student. We subscribe to a nursing magazine and we often discuss the articles - I often take the theory perspective and he takes the "real world" perspective. A recent article reported that diabetic patients need to keep their hospital blood glucose levels at 120 or below to promote optimal healing, but my husband said that it is not practical. We are in a rural area and many people here do not receive preventative care. He says that when you have no idea what a patient's baseline blood glucose level is, it is dangerous to try and lower them to that level. He said that that he has seen patients exhibit hypoglycemic symptoms at 180 because they have been living with a baseline of 300 for so long. His example was that a patient who comes in at 160 must be lowered slowly over the course of a hospital stay because they could bottom out if brought down to 120 too quickly. Is this true and would you consider this a correct practice?

[blondy2061h, MSN, RN]

It's true that someone who has been consistently having high blood sugars will feel hypoglycemic at normal or even high-ish numbers, but it's not dangerous, just uncomfortable. Aiming for 200 one day, 180 the next, 160 the next, and eventually 100 can prevent this, ie, going downhill slowly. Ultimately, having normal or near-normal blood sugars is necessary to prevent severe complications.

[Mr.RN-CDE]

High blood sugars put in-patients at high risk for infection among other problems. This is a problem everywhere. Our team is struggling with this and trying to get docs to recognize what a serious problem hyperglycemia is. We have heard that under new Medicare guidlines, if hyperglycemia is not addressed it will effect reimbursment. I think that this will actually help. If it means dollars, docs and hospital administration will finally take hyperglycemia seriously.

[carluvscats]

I'm a pretty new nurse, but my husband is diabetic, so from my experience, what your husband says is true. My not-so-disciplined husband got busted on his A1c at his last visit, and the doctor put him BACK on meds to get his blood sugar down, but was told it would take a couple weeks to do so safely, since he had been running high for probably at least a year or maybe two.

One thing to be aware of ~ and I'm sure your husband can testify to this ~ is that moods are tied into blood sugar levels. My husband got weepy and irritable when he was getting lowered. Just something to keep in mind, that these patients will need your extra patience. :)

[BrnEyedGirl, BSN, MSN, RN, APRN]

Some times I see the same sort of thing with pts that start on BP meds. The pt who has ran 200/110 for the past year or more will often feel tired and even light headed at 110/65. It obviously isn't harmful, but not fun. They eventually get readjusted to a normal BP, and of course bringing them down slower will encourage compliance with meds.

[truern]

Before I was diagnosed with cancer, my BG was WNL with metformin and diet, but after the diagnosis my system went haywire! I was put on insulin after it was discovered that my BG was typically >300. The day my BG went down to 110 I was on the deck throwing up and shaking like a leaf....I felt as though it was 30-40! Granted a normal BG is conducive to healing, but you have to weight the effects of lowering it too fast. jmho.