What is something interesting about "diabetes 2" I could share?

mursetudent25 · Dec 2, 2011

what is it that 'we already know'? :)

llg, PhD, RN · Dec 2, 2011

How many people can prevent and/or reverse it if they act promptly and aggressively in the early stages.

Does your group know about that?

AgentBeast, MSN, RN · Dec 2, 2011

No offense, but it's kind hard to answer a question like "What is something interesting about Diabetes Mellitus Type II that we don't already know?" when we don't even have a clue what you already know.

xtxrn, ASN, RN · Dec 3, 2011

It's progressive- most people end up on insulin at some point- and recent studies show that earlier introduction of insulin prevents later complications in COMPLIANT patients.

It's the most common form- yet the public thinks about Type I as "real" diabetes.

Regular "treats" can be accommodated into the meal plan.

Insulin to carb ratios are VERY individualized. You can have one person take I unit of a fast acting insulin for every 15 gms of carbs (1:15) , and someone else need 5 units for 15 gms (or 1:3). It takes months to figure it all out- and it all goes nuts in the hospital :)

Type II CAN go into DKA, although it's uncommon.

Most insulin pen tips and syringes are now made with 29-31g needles- virtually painless. MUCH improved over even 15 years ago.

Medicare won't cover the insulin pump. It's only been in the last 15 years or so that they covered strips and monitors to DM patients who were on oral meds- even though they are at risk for hypos. This matters with compliance and control with brittle diabetics.

Treating a hypo MUST include some sort of protein/fat snack if the next meal is more than 30 minutes away- or there is a rebound hypoglycemia. BUT, do not give the protein/fat snack until the blood sugar is up in the normal range, or it will interfere with the stabilizing of the blood sugar.

Peripheral neuropathy includes autonomic symptoms - it's not all about pins and needles in the feet :)

It's a PITA to be in the hospital with the sliding scales that are useless - there is no one sliding scale fits all...ASK the patient if possible what they do at home, and how they manage their meds and testing- I can guarantee that most don't do anything like the hospital does- and it's still ok :)

The patient is THE expert on their DM2. (or DM1). Living with it and reading about it, or following some cookbook doc's orders are WAY different

Sometimes Lantus or Levemir can be given BID to get the optimum 'numbers'. Some diabetics use SO much insulin they have to use U-500.... In 19 years of active work, I never saw it. But I've heard about it....gotta be VERY careful.

Metformin can be mayhem on the GI tract. Listen when the patient says it's miserable. (it is !!).

Non-compliance can be a result of financial, vision, denial, etc- it's not always some blatant ignoring of the instructions/meds. :)

Most insurances cover outpatient dietician appointments to work out a food plan...

Good luck :up:

rn/writer, RN · Dec 3, 2011

Here are links to several blog articles I wrote about type 2 diabetics.

https://allnurses.com/nursing-blogs/those-darn-diabetics-640099.html

https://allnurses.com/nursing-blogs/dirtiest-word-chronic-637833.html

Healthcare workers need to understand that it isn't about hammering people with education but rather giving them a vision that is reachable and goals that are doable, especially when they are newly diagnosed. Education is great and necessary if the person is ready for it, but far too often the patient is overwhelmed and overloaded with rules and widgets and they decide not to be diabetic. If given some time to get over the shock and take in some of the information, they might be a lot more willing to make important changes.

Hope this helps.

Cuddleswithpuddles · Dec 3, 2011

What about beliefs and folk remedies different cultures have for diabetes management? You can focus on patient populations that hospitals in your are commonly encounter, and how these beliefs and practices impact the care nurses and doctors deliver. This is particularly important if there are any interactions between the folk remedies and common medications for DM. Might be a good eye opener for everyone :)

Cuddleswithpuddles · Dec 3, 2011

Type II CAN go into DKA, although it's uncommon.

This definitely surprised me. It surprised veteran ICU nurses as well. I had a patient who was in her 40s, recently diagnosed with DM2 but came in with DKA. I was puzzled, asked around and everyone scratched their heads as well. I definitely had to do some poking around beyond our "official" textbooks to find a resource that definitively stated that, yes, people DM2 can go into DKA.

xtxrn, ASN, RN · Dec 4, 2011

Yep. A LOT of stuff is "daily" for diabetics that never makes it to nursing school. When I was turfed off to a diabetic teaching class when I was diagnosed, I felt like THE moron of the class. I was supposed to be taking care of diabetics..not feeling like a total dork. I was diagnosed as a result of a pre-employment physical w/UA.....the glucose was off the chart. The employee health nurse called me up (I'd worked there before , and knew her) and she handed me my UA report, and asked if I saw anything "off"..... glucose > 2000.... I busted out crying.

I was SO lucky to have an employer who got me off to classes, had the supervisors aware that I was a new diabetic, so if I felt funny, check it out (one sup used to drag down cheese sandwiches anytime I said I was tired - she was so sweet about it all). I had a lot of support, and subscribed to "Diabetes Self-Management" and "Diabetes Forecast"- which is where I get a lot of info that doesn't make it to nursing texts.

Hellostudentnurssee · Dec 7, 2011

Wow, thanks everyone! Great information!!! I'll definitely use it!

CrazierThanYou · Dec 7, 2011

It's progressive- most people end up on insulin at some point- and recent studies show that earlier introduction of insulin prevents later complications in COMPLIANT patients.
It's the most common form- yet the public thinks about Type I as "real" diabetes.
Regular "treats" can be accommodated into the meal plan.
Insulin to carb ratios are VERY individualized. You can have one person take I unit of a fast acting insulin for every 15 gms of carbs (1:15) , and someone else need 5 units for 15 gms (or 1:3). It takes months to figure it all out- and it all goes nuts in the hospital :)
Type II CAN go into DKA, although it's uncommon.
Most insulin pen tips and syringes are now made with 29-31g needles- virtually painless. MUCH improved over even 15 years ago.
Medicare won't cover the insulin pump. It's only been in the last 15 years or so that they covered strips and monitors to DM patients who were on oral meds- even though they are at risk for hypos. This matters with compliance and control with brittle diabetics.
Treating a hypo MUST include some sort of protein/fat snack if the next meal is more than 30 minutes away- or there is a rebound hypoglycemia. BUT, do not give the protein/fat snack until the blood sugar is up in the normal range, or it will interfere with the stabilizing of the blood sugar.
Peripheral neuropathy includes autonomic symptoms - it's not all about pins and needles in the feet :)
It's a PITA to be in the hospital with the sliding scales that are useless - there is no one sliding scale fits all...ASK the patient if possible what they do at home, and how they manage their meds and testing- I can guarantee that most don't do anything like the hospital does- and it's still ok :)
The patient is THE expert on their DM2. (or DM1). Living with it and reading about it, or following some cookbook doc's orders are WAY different
Sometimes Lantus or Levemir can be given BID to get the optimum 'numbers'. Some diabetics use SO much insulin they have to use U-500.... In 19 years of active work, I never saw it. But I've heard about it....gotta be VERY careful.
Metformin can be mayhem on the GI tract. Listen when the patient says it's miserable. (it is !!).
Non-compliance can be a result of financial, vision, denial, etc- it's not always some blatant ignoring of the instructions/meds. :)
Most insurances cover outpatient dietician appointments to work out a food plan...
Good luck

Excellent information! I have to say though, my shots still hurt, even with the 31g needle! :eek:

Yes indeed, metformin can give some mighty... interesting? symptoms.

And bravo to the part about the noncompliance!