What to do with Non compliant Diabetics???

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I had a patient recently G4 P2, 18 yo, 2 prev C/S. Diagnosed just before 1st pregnancy with Type 1 Diabetes. Currently blood sugars in 300++, on insulin drip to get them under control and 25 weeks(by 7 week US) gestation although baby measures 28 weeks via US. She has been non compliant since she was dx with IDDM 4 years ago. Her last baby was 12lbs at 37weeks:uhoh3:!!! I tried to discuss with this girl the risks of having uncontrolled diabetes in pregnancy and not in pregnancy. Including blindness, renal failure, amputations etc. I told her the way she is going she is likely to be on dialysis in the next 10 years if not sooner. I'd hoped i'd gotten through to her during my 17 hours with her(was a long shift), we did lots of talking regarding her disease and its effects on the baby as well. Once they got her BS stabilized she was transferred to the antepartum unit and off the drip. She told the nurse she didn't want her 2200 sweet success diet tray because she wasn't hungry, then her mother brought her fast food and SHE ATE IT!!! How do you get through to these patients????? Will it take her coming in with a dead baby to get through to her???? I hope not, but i'm not going to be suprised if that is the result.

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Specializes in LTC , SDC and MDS certified (3.0).

Nothing you say is going to get through!! Just keep teaching Maybe a psych consult??

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All you can do is continue your education and document the refusals/non-compliance along with the education attempts. Some people are not going to follow diets no matter what happens. We had a woman who was 35 come into our LTC facility with a G-tube and a J-Gube due to diabetic gastroparesis. The G-tube was for drainage and the J-tube was for feeding. She would sneek all kinds of snacks when her stomach was supposed to be resting. Then when she was allowed to have food again, she ate everything that was not on her diet. Her favorite was raw fruits and veggies which is a huge no-no. Her parents was so upset with her but even they could not persuade her. Oh! And you ask, how did she get this bad? She was non-compliant diabetic plus a bulimic. She did not have a chance. She was in my facility for almost two years. Went home and has been in and out of the hospital right away. She will never get fixed. She does not care.

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Just continue the education, as already mentioned. You just can't make anyone do what they don't want to do. I just had a THIRTY-TWO year old girl come in for her SECOND cardiac bypass. (First one at age 28, complicated by sternal infection and open chest) She's already had a kidney transplant and it's failing, she's back on dialysis. She almost didn't make it through this surgery, she coded...bought herself a pacemaker after surgery. She's a good kid, but her husband and sister would pick up Applebee's food for her after surgery....she just wouldn't eat our food! All the teaching in the world just wasn't getting through. Great family, but so scarily non-compliant! Sad. :( Not the only patient we've had like that either, but probably the youngest with those problems.

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Specializes in ER, SICU.

As a nurse who happens to have diabetes, these posts drive me crazy. I hope nobody takes offense to this, but you have NO idea what it means to be a "compliant diabetic." I understand that you don't understand how someone could not take care of a disease, especially when you know the associated complications. Having insulin dependent diabetes is so incredibly hard. I'm here to tell you to have compassion and understanding for these patients. That is the best thing that you can do for them. Fortunately I am compliant, however I was not always this way. It takes an unbelievable amount of work, it is a daily struggle.

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As a nurse who happens to have diabetes, these posts drive me crazy. I hope nobody takes offense to this, but you have NO idea what it means to be a "compliant diabetic." I understand that you don't understand how someone could not take care of a disease, especially when you know the associated complications. Having insulin dependent diabetes is so incredibly hard. I'm here to tell you to have compassion and understanding for these patients. That is the best thing that you can do for them. Fortunately I am compliant, however I was not always this way. It takes an unbelievable amount of work, it is a daily struggle.

I can sympathize with you completely. I remember in nursing school thinking that Diabetes seemed like one of the most difficult diseases to manage, esp IDDM. But this pt of mine wasn't even trying!!!! No effort at all. She wouldn't even pretend for the sake of being in the hospital and us watching everything she put in her mouth. I realize this girl was young, but every member of her family was a diabetic and she should know better. And she isn't only hurting herself she's hurting her unborn baby and her children at home that have a very high chance of being IDDM. What will they learn by watching their mother eat whatever she wants and completely ignore her Diabetes. There is no excuse for this behavior except selfishness. I'm happy to hear you are compliant and i'm sorry for the daily struggles I know you endure.

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Specializes in Nursing Professional Development.
As a nurse who happens to have diabetes, these posts drive me crazy. I hope nobody takes offense to this, but you have NO idea what it means to be a "compliant diabetic." I understand that you don't understand how someone could not take care of a disease, especially when you know the associated complications. Having insulin dependent diabetes is so incredibly hard. I'm here to tell you to have compassion and understanding for these patients. That is the best thing that you can do for them. Fortunately I am compliant, however I was not always this way. It takes an unbelievable amount of work, it is a daily struggle.

I understand what you are saying and agree completely. I recently developed Type II diabetes and it is unlike any other condition I have had to adjust to in my life. It's hard to describe exactly HOW it is different, but it IS different.

I have hypertension, bad kness that hurt most of the time, mildly arthitic hips, irritable bowel sydrome, 60% hearing loss, a balance impairment, constant tinnitus, mild reflux, and intermittent plantar fasciatis. I have successfully adapted well to all of these chronic conditions and I have adapted well to my very mild diabetes (caught very early and as of yet, well-controlled on diet and exercise alone). But the diabetes is different from my other conditions. I can't explain it totally, but it is different.

Yes, the young woman in the OP's original post should do a better job. But nurses who don't empathize with the struggle that diabetics face daily don't help their patients. If anything, they make it worse ... and trigger rebellion that includes noncompliance. It's a disease that has its own complex psychology as well as it physical manifestations.

I am just beginning my journey with diabetes. While I hope to delay the need for medication for several years, I know that it is unlikely I will succeed forever. The disease will progress ... require increasing intervention ... and eventually hasten my death. And all around me, there is food I should not eat -- and advertisements for yummy foods I will never be able to eat again without guilt and some health care provider condemning me for simply eating the foods that everyone else eats ... that I must eat ocassionally for nourishment ... food that nourishes me and kills me simultaneously.

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