Monday, March 30, 2009

INTRODUCTION TO DIABETES

I have a friend who is diabetic. I love the way she states "Diabetes doesn't define me, but it helps explain me." She has reached a point of acceptance with her diabetes that I have not reached yet. I hope that I eventually arrive at the same spiritual point with my diabetes.

I am a nurse who has taught diabetes for more than 20 years, but I was only diagnosed with diabetes a year ago. I have found out that the things I have always taught are true, but incomplete. I have always mentally accepted the vagaries of diabetes and now I have to emotionally accept the consequences and effects of diabetes in my life. I believe this will be a journey that I will continue to learn about for the rest of my life.

Diabetes is different for every diabetic. Our bodies respond differently to stress, exercise, food and medication. Our physician and our dietitian become some of the most important people in our lives as we learn about OUR DIABETES.

So I would like to go through my teaching that I use with patients and personalize the lessons. This will take several posts over the next few weeks. I hope others find reading these as rewarding as I hope to find writing them.

I will begin with the simple statement that "every diabetic is different and their treatment plan is as individual as their face. Their treatment plan must be worked out over time between them and their doctor." We must all find a doctor that we can speak comfortably with and trust their care. This allows for a better working relationship between them and their doctor. I have even stated that working with a doctor they could communicate with and trust was one of the most important factors in successful treatment for diabetes.

The new diabetic will be started on a diet and medication regimen by their doctor. Most diabetics will be asked to check their blood sugars at home. The good news is that these machines can be obtained for very little money or even for free. The companies who make the monitors provide a certain number of free monitors because only their strips will work and you then have to buy strips. Most insurance companies and Medicare will help with machines and strips. I prefer a monitor that allows me to check my blood sugar on my hand or forearm.

Monitoring blood sugars allows the diabetic and their physician to see the effects of medication, diet and exercise. I have found it amazing how blood sugars can be elevated from some foods that I thought were OK and see very little elevation from foods that I thought would create a problem. One on my patients has a very large increase in blood sugar from 1/2 of a slice of bread, but very little from a serving of regular Vanilla pudding. The pudding contains sugar and I thought he would see an elevation of 100 points when he actually had and elevation of only 25 points.

Speaking of blood sugar brings me to the final subject of this blog. What is Diabetes? Most people believe that diabetes is a problem of high blood sugars. It is not having an elevated blood sugar!!!!!

Diabetes is a shortage of insulin in our bodies. Our blood sugar builds up in our blood stream when there is not enough insulin to carry the blood sugar into the cells where it can be used for as fuel for the cells. When our cells do not receive enough blood sugar they become damaged over time. This is what can cause the wide spectrum and devastating complications associated with diabetes. Treatment is usually designed to balance a reduced need for insulin with supplementing the bodies production of insulin. Both result in a lower blood sugar as less foods are converted to blood sugar and more blood sugar is carried into the cells of the body.

Wednesday, March 25, 2009

Little Miracles are Precious

Oh Happy Day. Saw a former patient last night. I can't tell you her name without breaching confidentiality, but I can share some of the info that makes her special to me.

She had entered another hospital for a simple procedure and been through every complication that could happen. Her overnight stay had lasted six weeks and she was sent to us when there was no longer any hope for survival. We started caring for this woman (I'll call her Nancy) when she was not expected to live more than a few days to weeks. She needed additional surgery, but the surgeons believed she would die on the table if ANY surgery was attempted. They refused to operate.

I have seen this before and we spent more time with the family. Their need for emotional support almost overwhelming. We tried to be honest with them since the outcome was unknown. Nancy did not have a terminal illness. There was not a terminal disease causing the end of her life. There WERE many serious problems that made each other worse. The doctors could not treat one without making another worse. We believed that no human had the physical reserves to survive and she was very close to death.

We prepared her daughter and her husband for her impending death. We allowed them to cry on our shoulders as we cried with them. We listened to her daughter speak of how she learned to be a mother by remembering the way Nancy raised her. We encouraged the family to spend time with Nancy and we ignored the visitation hours. We all accepted that Nancy was going to pass away.

Medical care and nursing care continued even though we did not expect more than life to be prolonged for a few weeks. Nancy had "the look" of deathly illness that so many Nurses and Doctors have come to recognize. "The Look" makes healthcare professionals feel helpless. We know our patient is critically ill and there is so little we can do to help. We also know that we are not Gods and do not really know the outcomes. We do the best we can as we fumble in the dark trying to help others.

For seven weeks we continued to follow the treatment with very slow and very slight improvement in Nancy's condition. Her husband spent less and less time with her as we watched his grief increase. Her daughter tried to remain hopeful but, I knew she was struggling as she brough Nancy's grandchildren in and pretended there would always be time to see "Nanna" when she was better.

The family and the staff became rundown from the stress. Yes, the staff becomes attached and the stress builds for them. They will not feel the same loss as the family, but the stress of a dozen episodes a year takes a large toll for the caring staff involved.

Monday morning of Nancy's eighth week with us and her fourteenth week in the hospital I noticed an difference in her attitude and appearance. Her skin was not as grey and lifeless as on Friday. She smiled at me and stated she felt better for the first time. She could stand with help for the first time and her voice was soft but not a whisper. I worried that this was the "Rally before the End."

Tuesday she walked to the bathroom alone.

Wednesday a stomach X-ray showed that she was getting better rapidly.

Friday she went to Rehab to get her strength back.


That was three Months ago.

Now this strange woman walks up to me and gives me a big hug and says thank you!! This woman recognized me but, I was unable to remember her. Then I saw Nancy's daughter. I was soooo embarrassed!! I know she looked different but it was still embarrassing.

How could I forget Nancy!!


I cried again. With joy and with Nancy. This is why we do all that we do.

Tuesday, March 24, 2009

Who Is Richard, RN?



Wow!! What a question to start a blog with. Who is Richard,RN? Who I am, what I believe in, and what makes me different are important questions when people are deciding to read a blog.

I am a Registered Nurse. I have been an RN for over 20 years. How I became an RN and some of my history before nursing are stories for the future. All I will say for now is that I have had "an interesting life."

I have worked in ERs, and ICUs for most of my career. I posses an insatiable curiosity about how things work and why they work that way and I love to share any knowledge I acquire. My curiosity is quite eclectic (I had to look up this word but it works so well some times.) This means I learn about healthcare, alternatives to modern healthcare, computers, blogging, marketing, dieting, TV, Movies, Books etc. etc. I spent years with my youngest daughter watching science based TV like CSI with a laptop between us as we researched the actual science as they were presenting something on TV. Found out lots of stuff that was fun to know. And some of it was pretty useless, but my daughter now loves science. My eclectic curiosity may pay big dividends for my daughter.

I love teaching my patients and their families. A great deal of information is available to the public on heathcare issues such as diseases, medications, treatments and a thousand other questions that I have been asked to answer. But how do my patients and their loved ones find this information? How do they translate Medical Speak to something they can understand. An article written by some pharmicutical geek with 2-3 PHDs is difficult to understand when you are a 65 year old immigrant from Thailand who works hard but can barely read and write 3rd grade English. The Medical Speak his doctor uses isn't much better and the nurses frequently give information so incomplete that it is worse than useless. "This is your heart pill" doesn't help when they take 4 medications for their heart. I enjoy the challenge of translating Medical Speak to something that can be used by the patient and their family.

I believe people are more likely to make wise decisions when they UNDERSTAND what is being said to them by healthcare professionals and how their choices effect them as a patient.I would like to help others and hope this blog allow me to perform this service. Write comments. Ask questions. I don't promise to have the answers, but I will share what I can and what I learn. We can learn together.

So, ask me what you want to know. Tell me what you already know. Let's talk, chat, laugh and just help each other.