May 5, 2007, 5:47 pm

I’m Worried About Him

midol
Hmmmm…

Call me crazy, but if you have dysmenorrhea doesn’t that mean you already have symptoms?

Otherwise, you wouldn’t have dysmenorrhea, right?

And this “antispasmodic”: cinnamylephedrine. It was also a potent anesthetic and caused spinal cord paralysis in frogs.

Oh, I gotta get me some of that!

And it was far from “exclusive”. Extensive research on my part, aka a Google search, shows it was everywhere.

They probably took it off the market because people were making cinnamon-flavored meth out of it.

It isn’t in Midol anymore. Midol does have an antihistamine guaranteed to knock you on your caboose. Alas, the only “stimulant” it now contains is caffeine.

Heck, a good Venti, non-fat, extra hot Dulce Latte with an add-shot from Starbucks will give you more bang for your stimulant buck.

Trust me.

******************************

I’m worried about him.

Young guy, looked healthy. Shows up to the ER at 0400 with a couple of family members.

He didn’t speak English.

It didn’t help that his symptoms were nebulous at best. They were so vague his translators had a hard time putting them into words.

His body was numb.

Okaaaay.

His mouth was dry.

Okaaaay. “How long has this been going on?”

One month.

“So what is different tonight; what made him feel he had to get to the ER right now?”

“He says he feels like he is going to die tonight.”

*****

Huh?

The patient spoke awhile to his translators.

“He is always thirsty.”

Oh no.

I asked him in Spanish if he was urinating frequently and a lot.

Yep.

Oh no

I put him on the gurney and grabbed a fingerstick blood sugar before I did anything else.

390. Well, that explains it.

I threw in a line, grabbed the blood, started saline and called the doctor to the room.

New onset diabetes Type 2.

A little insulin, a little fluid, a few hours of monitoring and the blood sugar began to come down.

*****

I knew we could get his blood sugar down, that wasn’t the issue.

How do you explain to someone that they have diabetes when they don’t speak English?

His translators did their best trying to explain exactly what diabetes was and what it would mean to his life in terms of health care, diet, checking his blood sugar. I tried to make the information as basic and informative as possible. The patient just looked dazed and overwhelmed.

Then he asked his first question.

Would his leg fall off?

His only knowledge of diabetes was that an uncle had lost his lower leg because of the disease.

Oh boy. This was not going to be easy.

*****

It was going to be harder than I thought.

He worked for cash. No health insurance. No doctor. I couldn’t even really gage his ability to take in the information he was being given.

Eventually his blood sugar lowered to the point that he could be discharged.

Discharged.

When did we stop admitting new-onset diabetics? Where do you learn to check your blood sugar? How do you learn what you should and shouldn’t add to your diet? How do you learn about your medications?

Oh, we gave him a referral to the county clinic.

But the only diabetic teaching he left the hospital with was what he got from me. And I don’t even know how much of that he was able to comprehend.

I do know that he was going to have to go to a pharmacy and put out a minimum of $100 for the two medications and a glucometer. He was going to have to do blood sugar checks three times a day. He was going to have to change his alcohol intake, not just because of the diabetes itself, but because of the medications prescribed.

I went to the ADA site and printed all that I could find in Spanish. I gave him our discharge instructions in Spanish. I explained all I could through the translators.

He was quiet the entire time.

*****

Did he fill his prescriptions? Is he checking his blood sugars? Did he get into a diabetes education program at the county clinic? Is he even bothering to do anything to get control over his disease? Does he realize just what this can mean to his life?

I know it’s his responsibility and I have no control over any of it. I did what I could with what I had to offer him in the middle of the night.

But I can’t stop thinking about him.

Maybe because it was a year ago this month that my husband received his diagnosis of diabetes. I remember the shock, the initial numbness, the learning curve with diet and figuring out the new glucometer and the emotional roller-coaster that he went through after the diagnosis. I went through it with him and it was just as scary for me, and I knew what was happening.

Now, if I’m a nurse and was thrown by a diagnosis of diabetes, how much more would it affect someone who didn’t have a grasp of the basic concepts.

All he knew was that his leg might “fall off”. How frightening.

Maybe by letting him know that a controlled blood sugar could help him avoid an amputation in the future, I was able to impart some motivation to take care of himself.

I hope so.

I still worry about him.

15 Comments


  • BabsRN

    May 5, 2007 at 10:02 pm

    Yep, I remember the first new-onset diabetic we sent home. I was completely bumfuzzled. Presenting to the ER symptomatic with a 500 blood sugar and no known history and you go home? I don’t know what happened there…who changed the admission criteria or what. I know something’s gotta give there though.



  • Rhea

    May 6, 2007 at 6:49 am

    That’s sad that he came in thinking he was going to die. But if you don’t know what’s happening to you, I guess you could think that.



  • Kathleen Weaver

    May 6, 2007 at 7:18 am

    Just to make you worry a bit more. How do you know that he is a Type 2!

    Just because he is Hispanic doesn’t mean that he is Type 2.

    You said “healthy appearing young man”. You didn’t say a word about overweight.

    I know lots of Type 1 Diabetics who were diagnosed in their 20s and early 30s. Go look at Diabetes Mine?

    Probably nothing you can do now, and you’re not the doctor, but ….



  • Kim

    May 6, 2007 at 8:45 am

    Hi Kathleen, I sent you an email, but I wanted to put it down here, too. The ED doc wrote Type 2 diabetes as the dc instruction, but you are right, did we even know?



  • linda lou

    May 6, 2007 at 8:54 am

    Hey Kim,
    Just wanted to be the first to wish you a happy nurses week. It is a tribute to your character that you care so much about these patients to share them with us! I hope you have a good week.



  • Labor Nurse

    May 6, 2007 at 1:39 pm

    Kim, this story kills me! How do we even know it was diabetes??? Ya, his blood sugars were high, but did anyone look at any differential diagnosis? Was there something else that could have induced these symptoms?

    I am sure that it is type 2 DM, but how an MD could just send this man on his way leaves me speechless. Was it because of his lack of insurance? Or is this the new protocol? Would an affluent patient get sent home like this?

    And of course he understood none of what he was told; I’d worry about him too.



  • N=1

    May 7, 2007 at 1:44 pm

    link to blog detailing community-based diabetes management programs and nursing research in LA – perhaps you can contact the LA folks to get SF area program and contact info:

    http://newbricks.blogspot.com/2007/05/patient-team-empowered-diabetes-care-in.html

    Your post illustrates why nursing researchers and faculty need joint appointments, and why clinical nurses need routine access to them. It also highlights the need to be current in nursing research in one’s practice specialty, as well as involvement in one’s local professional nursing organization.



  • Fallen Angels

    May 8, 2007 at 9:06 am

    After reading your post I am (seriously) considering taking the “Spanish immersion for health professionals” course at my college before entering the nursing program. I plan (hope) to be a diabetes education nurse and we have a large Hispanic population in my area. I have always thought learning Spanish would be a good idea…now I think so even more.

    Sera



  • AmyT

    May 8, 2007 at 11:02 am

    Aaaaaaaaaaaccccckkkkkkk!

    Did you hear that?! That was me screaming bloody murder over here. Not just for this guy, but for the 40,000++ others like him. I’d be willing to bet you this scene plays out multiple times a night in LA County…

    Now I may need treatment for depression 🙁



  • map

    May 8, 2007 at 1:36 pm

    Do you see how many of these patient information sites are also in Spanish?

    http://www.nlm.nih.gov/medlineplus/diabetes.html

    Always check Medline Plus- most of the info also is in Spanish

    http://www.nlm.nih.gov/medlineplus/healthtopics.html



  • scalpel

    May 8, 2007 at 11:36 pm

    The other potential causes of hyperglycemia in a patient like that are so unlikely that it isn’t worth working them up on their initial presentation. And the likelihood that he has Type I diabetes is also so low that it would be silly to start him on insulin right off the bat.

    The vast majority of such patients will do just fine for the week or two until they can follow up somewhere on a simple, inexpensive old-fashioned oral medication if they watch their diet and check their sugars every now and then.

    You can’t expect too much at them initially; 3X/day fingersticks is a nice goal, but in reality isn’t likely to happen. A full diabetic diet is too complicated; just tell him to lay off the booze and carbos at first. Tighter control can be obtained later, if he bothers to follow up.

    Did the physician not do any teaching? I usually spend about 15 minutes on new diabetics giving them my diabetes lecture. They probably don’t remember much of it.

    These patients aren’t admitted for the same reason healthy young patients with pneumonia or pyelonephritis aren’t admitted anymore. If you can walk out of the hospital, keep liquids down, and aren’t likely to die before you can followup, you don’t get admitted anymore. For anything, rich or poor.

    Unless you’re REALLY rich, that is.



  • CardioNP

    May 9, 2007 at 5:23 pm

    If he had no ketones in his urine and no anion gap it is unlikely to be type 1 diabetes.
    A glucose less than 400 does not require hospitalization.

    Do you refer any of your patients to Walmart for their prescriptions?
    He could fill a months worth of metformin and glipizide for $4 each. Much cheaper than $100 at the local pharmacy. Their meters are likely cheaper than the local chain pharmacy as well.
    Walmart’s generic Rx list:
    http://i.walmart.com/i/if/hmp/fusion/genericdruglist.pdf



  • CG

    May 11, 2007 at 6:15 am

    I was diagnosed in 1994 at the age of 31 with Type I diabetes on my to FL for vacation. I spent 1 night in ICU then 3 days in the hospital. I learned a lot from the staff and went on to have 2 kids. I would not be in the great shape I am today if it wasn’t for them and their instruction. Someone needs to change this.



  • scalpel

    May 11, 2007 at 7:28 am

    If bad outcomes occurred when new onset hyperglycemics were discharged home then we wouldn’t send them home. But the fact is that unless there are complicating factors or severe metabolic derangements, the risk of sending such patients home is minimal. Hydrate them up, get their sugar to the 200ish range, and adios ala casa.



  • George

    May 12, 2007 at 8:03 am

    I have to agree with scalpel.

    Unless there is a secondary issue to manage, most of the patients would be discharged with an appointment to the nearest health facility which can handle such cases. However, the doctor should spend some time to stress the importance of the disease, the need for treatment, and the maintaining good glycaemic control at all times. One cannot achieve this in a day or a week, but with time. To stress strict target goals from the beginning itself is often very stressful and often make them feel unachievable and demoralised.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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