Diabetes Notes

To Each Diabetics Own…

by Kendra James, RN on April 6th, 2007

While at work yesterday I was reminded of just how different diabetes is for each patient. I work on a cardiac floor so at least 75% of my patients are diabetic, or are in the process of being newly diagnosed, based on my math over the last 8 years.

In one room I had a patient whose blood sugars were running in the mid 200’s. Isn’t that high you ask? Yes! But what you have to understand is for this particular patient, 550 was high. Yup, I said 550.

He has been a diabetic for 5 years and tried several medications, including different insulin regimens. Baseline for him is 200-ish. This is were he lives, functions and feels “normal”. As clinicians, we insist that blood sugars should be much less than this, somewhere near 120.

In our narcissistic ways, we expect patients to conform to our expectations. Well guess what? A blood sugar of 120 doesn’t work for everyone. I know, I know, I have a biology degree and understand the pathopysiology behind diabetes and the affects it has on ones body. However, I am also a nurse and have seen patients, like above mentioned, go into a hypoglycemic type crisis when we bottom their “norm” out.

Against my better judgment, I am still kicking myself over it, I went ahead and gave the very increased amount of insulin and oral medications. What can happen, we will only bring them down to the low 100’s? True, but that was way too low! Sweating, shortness of breath, heart palpitations, spots in the eyes and countless other complaints is what I had to make better over a 60 minute episode.

After a very long hour, we had success with stabilizing the patient. That was lesson number one on the day. Next? You know there had to have been more. If not, I just wouldn’t have earned my pay!

I received a direct admission patient from a doctors office. We started a line, hooked him up to monitor, evaluated vital signs and EKG, ordered appropriate meds, checked home medications, filled out paper work and spoke with the patient for 30 minutes or so about health history and reason for admission. Yes, my job is so glamorous. LOL.

Well, guess what little mister forgot to share? He was a diabetic, and did not take any of his medication that AM. That would be classified under useful information. Fifteen minutes before the end of my 12 hour shift, that is always when things happen, he calls me into his room and has very similar symptoms of the above mentioned patient.

I checked all his labs, they were good. His vital signs were within normal limits. He had no EKG changes. According to all his “numbers” there was nothing clinically wrong with the man. But looking at his eyes, I knew he was in distress.

Finally the eureka moment came. “You know I am a diabetic and didn’t take my meds?” Ah, no I sure didn’t know that. I guess I had forgot that crystal ball of mine. His blood sugar was 161.

That isn’t that bad, right? For the above mentioned patient, but not for this chap. His norm is in the 70’s to 80’s which means that 161 is very high for him. He has been a diabetic for 15 years and does not usually fly above 125.

So, We gave him some insulin and “fixed” him right on up.

My point to this very long winded recount on my day at work, every diabetic has a different range and controls their diabetes a different way. As a clinician, I need to respect my patients input and as a diabetic I need to be my own advocate.

Share This

Related Stories

Can poor-fitting shoes increase the risk for amputation in diabetics?
Britain reassessing driving rules for type 2 diabetics
Soaking your brown rice is good for your diabetes
Bill passed in support of diabetics
Link between low testosterone and type 1 diabetics

POSTED IN: Diabetes Management, Inspiration