Ok, so I'm a school contract nurse through a home health agency working with a very young diabetic patient. The school is great, couldn't be more supportive of my role and continuously praise my efforts at keeping the client's blood sugar levels within range. That being said, the parents are much less than cooperative, downright non-compliant mostly. They have the "feed whatever whenever and cover with insulin" mentality, and cannot seem to understand why I won't jump on board with their dangerous, and if I'm honest, abusive behavior. After a particular incident occurred recently in which the client's blood sugar was well above the MD's range for the client, I refused to give the client a sugary, carb-filled treat with the client's classmates. I discussed the situation with my supervising RN as well as the school principal and we all agreed that adding fuel to the fire was a big no-no for BS levels, regardless of the fact that everyone else was going to have the treat. The client's parents were informed well ahead of the event that the class would have said sugary treat and could have brought in a diabetic-friendly alternative but did not do so. Furthermore, the parents called my employer after I clocked out to inform them that they were furious with me denying their child the sugary treat since everyone else had it (I took my client onto the playground so nobody ate in front of client) and since BS was high and I had to treat with insulin anyways why couldn't I just give the kid the treat?! Well, after much griping, my RN mgr decided to call me and determined it would be best if I were to take the next day off-without pay!!!- to let everyone cool down. So, what can I do about this whole situation? Keep my mouth shut and poison the kid next time like they wanted me to do so I don't get suspended without pay? ~feeling like a flamin' bag o' poo after being stomped on a few times right now
Muno- If a diabetic in hospital asked me to get them a chocolate milkshake I would refuse, based on their ordered diet. But if their family member brought in a shake I wouldn't remove it from the room. I allow the patient to make their own choices, but I will not be a part of helping them worsen their health. Is that in line with your ideas about consent?
I don't get patient's chocolate milkshakes but that's because it's not something I have access to for any patient, regardless of what they should or shouldn't be eating. If we consider a different example that is generally made available, such as water, would you refuse to get a patient water if the Physician wrote an order not to give them water as a therapeutic intervention?
There is a school of thought called DAFNE- dietary approaches for normal eating. As a non-diabetic, my pancreas will release extra insulin to cover the occasional piece of cake, so the person with diabetes would administer the appropriate amount of exogenous insulin for it. I don't agree with the carte Blanche just eat whatever and take more insulin due to weight gain risk but it is overall safer to keep BG in range to match what the kid is doing.
There is a school of thought called DAFNE- dietary approaches for normal eating. As a non-diabetic, my pancreas will release extra insulin to cover the occasional piece of cake, so the person with diabetes would administer the appropriate amount of exogenous insulin for it. I don't agree with the carte Blanche just eat whatever and take more insulin due to weight gain risk but it is overall safer to keep BG in range to match what the kid is doing.
I take it you're British? I haven't heard that term in ages, since I used to be on message boards with diabetics from all over the world that would talk about their DAFNE courses. I had forgotten all about that term. That being said, I believe it stands for "dose adjustment for normal eating."
Another T1 question, what then makes a diabetic brittle even with pre striking or correction? Is it insulin resistance? But metformin doesn't help?
Brittle diabetic is a frowned upon term these days. The thought is with current technology, with the right approach, blood sugars can be controlled and if you label someone "brittle" that's akin to giving up on them and providing an excuse for poor glucose control.
That being said, it's more likely highly insulin sensitive people having harder times controlling blood sugars, as if their carb count is off by just a little even a little extra insulin can send their glucoses tanking and start a vicious high/low cycle. Personally, when I'm exercising a lot I have the hardest time with glucose control. It's a factor that heavily influences blood glucose control and is difficult to quantify.
Specializes in orthopedic/trauma, Informatics, diabetes.
We had a whole, huge discussion on a T1 board about the term "brittle" They were under the impression that it was derogatory and I was trying to explain, as a healthcare person, that it just was an old term to describe people that were hard to manage. The ones that I have experienced were ones that would go REALLY low (20s) for no apparent reason. Some of the other ones that I have encountered had multiple end stage issues: ESRD, blind d/t retinopathy, amputees, that sort of thing.
If you were a police officer who had just shot and killed the child, you would be sent home WITH FULL PAY while they investigated and most likely exonerated you.
But because you are an RN, and because you were advocating for the best health interests of the child you will lose a days pay to appease the employer.
In both cases the parents will be upset and will complain.
Both individuals are just "doing their jobs".
Isn't that special?
I think I would have answered the nastiness with a phone call to social services.
The parents are setting that kid up for failure. I went to high school with a guy who went blind in one eye at age 19, because his parents just let him do whatever he wanted and covered with insulin. I remember at 16, he was taking as many as 5 injections a day.
I think I would have answered the nastiness with a phone call to social services.
The parents are setting that kid up for failure. I went to high school with a guy who went blind in one eye at age 19, because his parents just let him do whatever he wanted and covered with insulin. I remember at 16, he was taking as many as 5 injections a day.
The parents may be in a state of denial.
When I was on shots I was easily taking 6-8 shots a day- 2 of Levemir and Novolog every time I ate or was above 150. And I had an A1c of 6%. More shots =/= worse.
When I was on shots I was easily taking 6-8 shots a day- 2 of Levemir and Novolog every time I ate or was above 150. And I had an A1c of 6%. More shots =/= worse.
This a thousand times! Why are healthcare professionals so afraid of insulin? It gives us the ability to live normal, long, healthy lives.
I didn't realize brittle was a derogatory term, I still read it now and then for the patient with difficult to manage glucose.
What I don't understand is why Dr's are still using sliding scale alone instead of adjusting for carb intake as well. I still get cooperative patients with poor control, usually just too high but occasionally up and down, and they're still on their long acting and regular old sliding scale. It was only this year that I heard my first 10-15:1 correction orders and only heard the carb adjustment dose in the last year or so.
@JulesA: I conferred with both my supervising RN and the school principal before moving forward with removal of said treat. The parents have been educated repeatedly over the course of many moons regarding proper nutritional choices and were asked to bring in healthy alternatives.
Here's my dilemma: if a child with a food allergy cannot have the same sugary treat and their parents don't provide an alternative then the school simply would omit said treat, correct? Yet, if a diabetic child has insulin handy go head and give it to them and just cover, regardless of the fact that said treat will do damage to their body the same way that a food allergy will do damage to the other child's body. Rationale for this: both conditions require medical intervention to keep the child from imminent harm, ie the food allergy needs epinephrine and the diabetic needs insulin so where is the difference?
You are completely correct. But none of this is for you to decide. Do you know how many patients I've educated on smoking cessation, just to see them outside smoking as soon as they're discharged? Yes I agree you're trying to do the "right" thing by the textbook. And yes the child's health depends on the "right" choices he and his parents make. But tbh I probably would have been upset if I were the parents as well. Unfortunately, his parents have more rights in decision making for their child than you do.
MunoRN, RN
8,058 Posts
I don't get patient's chocolate milkshakes but that's because it's not something I have access to for any patient, regardless of what they should or shouldn't be eating. If we consider a different example that is generally made available, such as water, would you refuse to get a patient water if the Physician wrote an order not to give them water as a therapeutic intervention?