was @ the doctor’s office this morning for a checkup. the nurse checked my blood sugar and it was 77. she insisted that i was hypoglycemic and told me she was going to get me some apple juice. i told her that i was fine and that 77 was within my target range. she read me the riot act and insisted that it was the clinic’s policy to treat any BG level lower than an 80, and i told her (not in so many words) to f**k off and take my vitals so i could see the doctor. eventually the situation worked out (she acted offended, took my vitals, and the doctor told me that he was glad i was maintaining control but to be a little nicer to the nurses next time). was i out of line here?
yes
The staff of my endo is very professional. But at my last visit I had a new nurse. The lab meter said 78 mg/dL and she was alert and recommended glucose tabs. I just said that the pizza from lunch will soon start to arrive (I was at the 3 hour mark). She was a little irritated but one nod from the experienced nurse silenced her. This is what happens when textbooks and reality collide. The problem is that they have to protect their patients and I can understand their concerns. Without the pizza load on board I think it is okay to insist. It can not harm to treat 77 with one glucose tab.
Yes and no…lol. It is nonsensical she was treating you as if you were hypo at 77 and disrespectful of your self management when you said you were fine. On the other hand it sounds like maybe you overreacted. Sometimes it’s hard when you’re annoyed at the many people who think they know how to manage your diabetes for you to tell them in a firm but polite manner that you are fine.
It is an ironic fact of the medical field that they are much more concerned with lows than highs. They are trained in fire fighting where the immediate danger (or perceived danger) is more important to respond to than the long term one. And then there’s malpractice.
My own example is I went to my cardiologist yesterday. The nurse always brings me in the room and tells me to strip from the waist up and put on a gown. The cardiologist and I just talk and I feel silly. So I’ve been “rebelling”, either saying “what for?” in an annoyed tone or just waiting till she leaves and staying dressed. Yesterday I just said, “No thanks, we usually just talk so it won’t be necessary” and she just said ok. It’s amazing how well it works to politely say “no thanks” when someone thinks they are commanding you to do something…lol
I don’t think you were out of line. What was your other option? Drink the juice and go high and need insulin for it? Please! I’d have done the same - or I’d have asked for a different nurse. I have no patience for people telling me what I need to do with my diabetes, and that includes doctors and nurses who are ignorant.
I think you could have told her in a nicer way that you don’t need juice. I often wake up in the high 60’s or 70’s and don’t feel I have to eat or treat it. I have been trying to lower my average bgs and often wait it out to see how low it will really go. I rarely go below high 60’s before liver kicks in. My dad is also a Type 2 and was told not to go below 130 because he would get a hypo and go into a coma. I think the medical profession is afraid of hypos for legal reasons and that may be why they have that policy. A glass of apple juice would send me spiking to 150.
Interesting, My Dr says a normal blood sugar is 70-100 fasting. I get into the 70’s often and dont have a problem there any more.
The nurse was just doing as she was instructed most likely but I am glad things worked out.
Juice would have sent you high & 77 isn’t hypoglycemic, but you could have been more tactful with her. When told things like this I say, “thanks for explaining your policy, but that’s not my policy.”
Well as you said, you did not actually tell her to f*** off. But I agree that being polite and firm usually works the best. Remember it may be annoying, but it IS the protocol she has to follow, and she can’t pour it down your throat lol (that would make a good story though!)
I think, in general, our defenses are on high alert when anyone says anything to us about our personal care. Sometimes we need to remember that not everyone is out there to get us, they are trying to be helpful. She didn’t know what you were doing prior to testing: maybe you just ate, maybe you didn’t and she sees the 77 as part of a downward trend so to prevent you from going lower she is doing what is required of her.
I’m not saying she was entirely right, either. Her attitude after you (assumably respectfully) told her you were fine was not very professional. And I would have mentioned that to the doctor, because he needs to know if his staff is not respecting his patients care.
Not out of line to refuse the juice.
But if you came close to telling her to f**k off I can imagine the tone of your voice. A little cranky, were we? You tone may have just confirmed her suspicion that you were hypo.
Anyway, sweetness goes a long way in a medical office, I find. Stand up for yourself, but be polite. Just because Dr. House is rude doesn’t mean we have to be.
Terry
I agree with others. You had every right to refuse the juice, but it’s best to be more diplomatic. I don’t blame you at all for being annoyed at someone coming into your life for less than a minute and telling you how to manage something you deal with 24/7. But she was only following an idiotic policy. We all lose our patience though. Not really a big deal for your part. That policy is inexcusable though.
It highlights a peculiar aspect of the medical community. They harp on us about tight control. Then they tell us that 77 is ‘low’ when we’re in an alternate universe where they have their office. If we drank juice every time we were 77, how would we ever be in good control??? It’s the same story when we’re in the hospital for other issues. The idea of ‘tight control’ goes out the window when they’re the ones that have to worry about it!! Our bodies, our choices. Stick to that for sure, but next time shoot the policy-maker rather than the messenger:)
probably could have been handled better but meters are not 100% accurate I wouldn’t accept juice for a 77 myself
I totally agree with this approach. 77 is definitely not hypo for me either!
I tend to agree with most of the comments. You were within your right to decline, but since she was only following policy, you might have tried being a bit nicer in refusing it. If she had insisted, you could have said, bring it, take a very small zip (barely to wet your lips) and leave the rest.
This is tough. As a medical assistant, I appreciate her concern. Not all patients understand their DM/ bodies and may need reminders. She might not know how long you’ve been diagnosed or what your typical range is, etc. But I would offer juice/ candy once, not insist and not repeat the clinic policy.
As a patient I have refused certain labs/ treatments, etc and some clinics have been pushy. However, my refusals were based on cost vs need (I know how outrageous some things cost and I know what I really need 
).
As a diabetic, I don’t treat a 77 period unless I feel its effect.
Maybe next time you see the nurse, just ask to start fresh. No one has to apologize but hopefully you understand each other better.
I don’t think you were out of line in refusing the juice, but agree with your doc about being a little nice. His day is going to be a long one thanks to you LOL. You don’t say but I suppose you weren’t exhibiting any hypo symptoms, however the nurse could have felt your comments indicated a lack of control and thought you were. Hopefully a note in your chart will eliminate this problem in the future. The “rules” simply do not always apply for some of us. And what nurse who sees D patients doesn’t know that a 77 could easily be above 80 if you consider the allowble variance? Too bad hypoglycemic is so totally misunderstood.
I have to agree that it might be both sides out of line, wasn’t there don’t know what you said or how. But since there is some debate on weather a low is below 60 or below 70. I would have pointed out the ADA guidelines of below 70 is considered a low. I personally look at it 70s are fine if I am not being over active or planning on driving, but I might want to grab a snack soon, keep it under 20 carbs and it’s fine. If I hit the 60s yep time to eat, if its near meal time great less insulin to pop, if it is going to be awhile I tend to treat myself to a cookie or something. I don’t use juice to treat my lows and save my tabs for when I hit the low 60s or lower, or if I am really busy.
I guess my take on it is to keep things in perspective. If fighting for your freedom to decide for yourself that you will not correct a BG of 77 at your endo’s office is a hill you are willing to die on, then the appropriate response is the one required to achieve that goal. If that’s what it took, that’s what it took.
If you look back on the incident and think to yourself that you could, maybe, have chosen a different reponse, or maybe gone ahead and took a sip of juice, no harm, no foul, then yeah, maybe you were out of line.
I wouldn’t, normally, correct a 77 just sitting at the doctor’s office either. I would have declined, but if making sure I correct a 77 was a hill the nurse was willing die on because of office policy, I probably would have taken a couple of sips of juice, no harm, no foul. I see my endo 4 times a year. Taking a few sips of juice at 77 4 times a year, at the most, won’t send my BGs spiraling out of control. Certainly before getting a CGM, I would have corrected a 77 before sitting behind the wheel of a car, so it’s not something I’ve never done before.