I hope this doesn't turn into a rant but it certainly could. I have been a pediatric nurse for 21 years and a Type 1 for 29 years. I currently work a small 15 bed pediatric unit in a moderate sized medical center. I am constantly amazed at how little your average healthcare worker knows about diabetes. From the pediatricians to the nurses to the child life specialists.
Most days it seems that I am the only one around knows anything. Which is scary! It just makes me so upset and yes sometimes angry when I see how things are being ordered or carried out for these patients by physicians and nurses just doing what they THINK is right. I know it's a lack of education but the patients are the ones getting the short end of the stick.
I try as much as I can to educate my co-workers and always tell them to come to me if they have diabetes related questions. And occasionally they do. However, they just don't get the basics....ugh!! I was recently asked to check an insulin dose with another nurse before she gave it to the patient. She showed me the blood sugar and we agreed by the sliding scale of the correct dose and she administered it. Later I found out that the blood sugar she based the dosing on was done AFTER the kid ate his breakfast not before. Typically, for small kids we don't dose until after the meal to make sure we cover all the carbs that were actually eaten. NOT checking the blood sugar AFTER eating. That's nursing 101.
And believe it or not the pediatricians are no better. Their philosophy is to just keep them stable until they get them to the outpatient diabetes center.
Do any of you have similar experiences? Are other healthcare professionals like the ones that I work with? Or is it just here? my location?
I too am alarmed at the lack of working knowledge many of the medical professionals display in my interaction with them over my 28 year diabetic career. I once was transported to the ER for an extreme hypo. Prior to my arrival at the hospital, the EMTs started a dextrose IV drip. I was conscious during the ambulance trip and the BG emergency was over when I arrived at the hospital. When I got to the ER, the nurses aggressively encouraged me to eat some cereal with milk. Later, my blood sugar was over 400 mg/dl and didn't drop below 200 mg/dl for 24 hours. The ER food was totally unnecessary. That incident put me on notice that I knew way more about my condition than most medical professionals.
I now realize how vulnerable I am if I ended up in a hospital or nursing home long term. No one can provide me with the customized insulin dosing that I provide myself. If I end up in that situation, I believe I will not survive very long.
The fact that "sliding scale" insulin dosing is still in use is an indictment of today's state of care for insulin dependent diabetics. I understand sliding scale to mean that the pre-meal insulin dose also takes care of bringing down high BGs. It's a reactive system that never truly pulls down high BGs.
I do understand, however, that the blood glucose management in most intensive care units is exemplary. They use IV insulin, check BG frequently, and maintain very tight control. Studies have shown that good BG control positively impacts the healing rate and preempts many post-operative complications. Unfortunately, BG control on the typical hospital floor is not given the attention it needs for optimal BG management. That needs to change!
I am also a nurse and my dtr stayed in a major hosp over night after a tonsils and adenoids due to 3 months into T1 dx and starting the pump the same week as her surgery. What a waste of time!!! The post op didn't even have a glucometer!!! They had to call a supervisor who took 20 min to bring one and by that time I just used her own and they said they could not use that result (but our glucometer was the only one we used on the floor and they were fine with that). In addition, they had no diet sprite/7up and we had to wait 45 min for it to make her a slushie. Once we made it to the floor, the nurse brought her a sugary slushie and we said she needed one with diet soda. She didn't realize our dtr was diabetic and said they didn't have diet and we should have brought our own from home. HUH? We paid $1500 out of pocket to stay overnight and manage all of my dtrs care since they didn't know the first thing about dm care or her pump (which I can understand the pump one to an extent). All they did was check her vital signs every 4 hours. NEVER AGAIN!!!!
In 5 years of being with Kaiser, and dealing with LOTS of doctors and nurses, there has been only one, a nurse practitioner, who was knowledgeable. Luckily for me I met her early on. She told me to read Bernstein, and do NOT follow the Kaiser diet. She saved my life I think. The thing I don't understand is diabetes is not some rare disease, lots of people have it in one form or another. So why don't medical professionals know more about it? I think one problem is that most of the ones who have had some extra training are on the ADA bandwagon and that just doesn't work for many of us. But you're right, most don't even know the basics. It has made me question whether they really know anything about other medical problems, either. So I do my own research and make my own decisions, but I'd sure don't prefer it that way.
I also do my own research and make my own decisions, and given the state of ignorance in the medical profession do prefer it that way!
My first indication was when I was first diagnosed and talking with an old friend who is a RN. For 25 years I had consulted this woman when I had a medical issue so I could ascertain what it was about and whether a doctor's visit was warranted. I trusted her knowledge and level-headedness completely. Then I found out how little she knew about diabetes.
Someone above said that the ICU management is spot on. My nephew's wife is an RN in a big city ICU and said they use Regular. Hmmm.
I too worry what will happen if I ever have to go to the hospital. I plan on talking to my doctor who is associated with our local clinic and hospital and ask him to write an order that if I'm conscious I be allowed to monitor my own blood sugar.
I have decided also that as long as I am awake and competent that I alone will manage my insulin needs while in the hospital. I have made that very clear with the several surgeries that I have had. I have also indicated that my husband would be the only other person to touch my pump. I have never had an inpatient stay since I was diagnosed at 15, but trust me, if I do, I will be in charge and if the doc doesn't like it they can find me one that does.
As far as the ICU comment, I know that in our PICU, the DKA kids that are put on drips, they use Regular for IV use.
I have been a hospital patient 2x for reasons unrelated to my D. I brought my own meter and test strips to do my own testing. I also called the kitchen and spoke to the head dietician to complain about my food. I was given pancakes with regular syrup and several packets of sugar for my coffee. She said she would "check into it." I never heard back from her. I made a ruckus about not getting a correction of insulin at night. I am on MDI. I said I would not go to bed with a 250 BG. The nurse in charge of me said,"They like to keep patients a little high to avoid any lows." I said to call my doc to get a correction ordered. I found the professional personel absolutely IGNORANT when it came to diabetes and its care. These are large suburban hospitals with excellent reputations for care. It is sad that we must be on alert for our lives when we are patients.
The additional thing I'd like to add, since I'm still all worked up about this, is having to deal with others judgments of diabetics, especially teens. I can't tell you how many times I've heard the discussion between healthcare providers, which include docs, nurses, and even social workers, about how these teens are "non compliant" and how terrible their A1c is. I've even heard these same people "bash" the dreams of the kids who want to become a nurse or doctor, by saying, well you can't even take care of your own self. Of course, that infuriates me. How dare they judge someone with no first hand experience of their own, no friends or family members with diabetes and perfectly healthy themselves. Grrrrrrr!! Most of the time I try to educate these ignorant people or at least try to make them see how hard it is to be a teen with a chronic disease that is something that needs to managed all the time 24/7. A lot of the times I just have to walk away. Otherwise, I might say something ugly which could get me in trouble.
I became a nurse because of my hospitalization with DKA at age 15. It was the providers that I had that inspired me to become a nurse. And I am just appalled at the things I see and hear.
And yes, like someone else mentioned, diabetes is everywhere. The nurses I work with are afraid of taking care of these kids because they don't know what the norm is or what standard of care is for in hospital care because insurance companies have dictated the way we treat these kids and they have to be discharged as soon as possible. Which may only mean an overnight stay. A lot of the times these newly dx kids don't even get admitted and go right to the outpatient diabetes center which is 2 hours of info and meeting with the endo. It's part of the the dumbing down of nurses, it's crazy... don't get me started on that subject.
All I ask for is for providers to be compassionate and educated and be an advocate for your patients! Is that so much to ask for?
I always think about what if I were a lay person, or I just didn't know that much about diabetes and I had to be in the hospital and leave someone else in charge of my diabetes care... that's freakin scary.
Thanks for sharing your experience, Peds. I think it is a very hard balance you have to walk. I'm sure each and every patient or relative whose loved one has been positively impacted by your intervention, shared information or even just kind words has very much appreciated you being there. So as frustrating as it must be for you, I know you've helped many.
I retired from Behavioral Health right before my own diagnosis. (And I fought my own battles with how our clients were treated!) If I was younger I would definitely work with PWD's from the emotional/psychological angle. Keep up the good work. It's nice to hear from someone "on the inside" who understands. Can you clone yourself? LOL. Personally I just respect medical personnel who are willing to say, "I don't know much about Type 1 management, please share what you do". Instead of "sure here is the ADA guidelines, eat 250 carbs a day, test your blood sugar when the whim strikes you and stay under 180."
My wife is an RN, and my mother a pediatrician-- they are both quick to point out that they knew very little about the subject until my situation forced them to learn...
Hi PedsRN, your experience is exactly what I've seen in my local hospital. I had emergency surgery, was in ICU overnight, and then on a regular surgery floor for the next 3 days over a weekend. The ICU care I received *was* exemplary. I was on a pain med pump and drifting in and out. I woke up frequently during the night to the very competent, compassionate night nurse checking my bg.
Then I was transferred to the general surgery floor where all my nurses were clueless. I received my first glucagon injection there when they overshot my insulin and then was crazy high because they never came when I called for a correction. I pulled out my own kit at that point, did it myself, and they were none the wiser. :)
I was so angry at the lack of knowledge in a hospital of all places. When I complained to my endo, he wasn't surprised, which didn't make me feel any better. I always thought you were supposed to be safe in a hospital...not so much if you have D. My experience has made me really fearful of having any medical procedures done under anesthesia of any kind.
I'm not a medical professional, but I can understand some of their difficulty. With hundreds of things going wrong with people, it isn't possible to understand the fine detail of all of them.
Anyone with a serious concern for doing it right, might have a more practical understanding of diabetes than most medical professionals.
But disasters can be around any corner. As someone mentioned, I (sort of) shudder at the thought of my BG being left 'a little high' at 250 for the night.
There's a diabetes disaster collection of mistakes mostly made by med pros. The one that stands out for me is a nurse giving 10 cc of insulin instead of 10 units. Patient died. It's at dosage mix up.
