Trying to teach a pt about Diabetes

lkwashington · Oct 30, 2010

Patient needs to check blood sugar before everytime he/she eats because the patient may not need the 70/30 insulin. Check blood sugar four times a day.

Sun0408, ASN, RN · Oct 30, 2010

The simpler you keep the instructions the better.. I know in the hospital for our pts that are on a sliding scale we check their sugar level at 8,12,5 and 9.. Of course the times can be adjusted to her eating schedule. But yes, if she is to get sliding scale at lunch/bedtime she needs to check it before getting any.. If she is new to this, I would have her check before breakfast and dinner also to make sure she is not dropping too low between bedtime and breakfast. She may not be eating enough for the amount of insulin she is getting or the amount may be too much for her. At least with the frequent checks, you will both know as well as her primary provider.. Keeping a log will help with any follow up apts.

If she is forgetting what to do and when, her regimen my need to be simplified.

tyvin, BSN, RN · Oct 30, 2010

I am officially confused; is she a type I or a type II?

As far as sliding scale always do the sugar; as mentioned she may not need any. As far as teaching suggest she keep a journal and suggest other visual reminders that could prompt her memory such as an alarm set for every time she needs to check. There are alarm clocks that can be set to go off up to 4x a day so she wouldn't have to set it every time. My phone has an alarm that can be preset to go off 3x a day so check out her cell if she has one. There are watches that you can program as well with alarms.

Another suggestion could be and I realize my suggestions require some expense but those answering agencies or whatever they're called. The people who you pay a small monthly fee and they call you at the given times everyday or however contracted. Messaging service that calls and says "it's time for whatever"......I like it; anyway, brainstorm with her to come up with more ways. The main thing she needs to know is that she needs to keep a regular schedule in order for her to manage her diabetes.

chingy1206 · Oct 30, 2010

She is a type 2. So even if she has routine doses of 70/30 ordered for breakfast and dinner, if her blood sugar is too low prior to administration of insulin, then u would hold the dose and have her eat. Now do you just skip that routine dose all together for that meal and move on?

Sun0408, ASN, RN · Oct 30, 2010

I would have her talk to her PP about holding if she is having a lot of hypoglycemic episodes.. You really wouldn't hold it or skip it because she will still need it.. Without it her glucose level could get very high.. The PP might have her wait til after eating to take her 70/30 if it was very low prior because the 70 is intermediate acting but the 30 is a rapid onset acting insulin. Again that is the PP's call. Teach her signs of hypo and hyperglycemia and what to do.

If you are unsure about how insulin works etc.. please read up and go to your employer and get clear, messing with insulin or holding a basal is a no no. The more you know and understand the better you will be able to teach your pt.

There are several good posts on here...

grannyrn65 · Oct 30, 2010

How about some imput from a R.N. who is a Type 2 and on insulin. Here is what I was taught, by my endocrinologist, when first started on NPH, I check my blood sugar upon rising in the morning. Unless my blood sugar is below 60, I go ahead and take my morning dose. In my case, 50 units of NPH. I then checked my blood sugar two hours after taking my first bite of breakfast. I then checked my blood sugar before my lunch and dinner and before going to bed at night. I would make adjustments if needed. I would also test again, two hours after th first bite of a meal. Once I got stable on my blood sugars, I could drop back on the number of times I tested.

As a nurse, I had to change some of my previous learn ideas. It is not a matter of simply learning to take insulin and test blood sugars, it is a matter of learning what foods I can eat, how much ex cerise I need every day, how other medications affect my insulin. Along with me having to change my previously held ideas, my nurses had to accept some things about me. When first diagnosed, in 1990, I though 'not me' and 'I don't have to follow a diet'. It took me two years to change my ideas. After that, I was able to control my blood sugars by diet and exercise alone. I finally went on an oral medication in 1997. And by 2000, after consulting with my doctor, on insulin. I went on insulin because it gave me better control. And for four years, I was also taking metformin, to help me.

There is an excellent book, which I will share if desired, that helps the non-professional learn how to use insulin and a sliding scale as well as testing blood sugar. What nurses need to understand is it is not a simple thing to teach a patient about Type 2. It can't be done in one, two or three meetings. And it involves other professionals, such as RD who specials in diabetes. And my peers, you have to learn that a good number have problems accepting and dealing with a chronic disease. When you see a non-compliant patient, I see professionals imposing their own attitudes The ways of treating Type 2 have changed over recent years. I am now on a sliding scale whenever I am in the hospital or on a medication that affects on blood sugar.

Good luck in teaching your Type 2.

GrannyRN65:)

grannyrn65 · Oct 30, 2010

And on my Birthday, Thanksgiving, Christmas and Easter, I am on a sliding scale of NPH and regular insulin. My doctor realises I tend to cheat on those days. Allowing the sliding scale and making adjustments in my NPH dependent on my carb load, helps me keep my blood sugar in a normal range of 120 two hours after eating.

GrannyRN65

snoshuz · Oct 31, 2010

GrannyRN65,

Please share the book you mentioned in your post regarding DM2 and teaching the non-professional. Thanks much for your helpful info.

grannyrn65 · Oct 31, 2010

GrannyRN65,
Please share the book you mentioned in your post regarding DM2 and teaching the non-professional. Thanks much for your helpful info.

Go to your search engine and type in:

Staying on Target

Your Insulin Adjustment Workbook BD

Several sites will come upon and you can print out a copy. I don't know about copy write. I have a copy, which I share and tell the patient to go the website to print their own.

Hope this helps.

GrannyRN65