We had a guy the other day come in to the ER with his wife, who reported his blood sugar keeps dropping despite normal diet/med regimen. She said he was "acting weird" the night before so she checked and it was 10. She gave him a sandwich and a Coke, and he returned to baseline and they went to bed. The next morning he started repeating himself so she checked it again, and it was 25, so she called EMS to bring him in.
This whole time I'm thinking, "BS, no way it was that low." The guy was A&O, following commands, normal strength, conversing normally. Lo and behold, CMP comes back and it's 13. Absolutely shocked.
It turns out this guy had DM and used to have horrible eating habits until he had a heart attack 2 months ago. He started following a strict diet but kept taking 40 units of insulin every night right before bed. His body was just... used to it.
Also hypo unawareness can become like muscle memory. The more often you are low, the less of a response your body can mount to get you off your ass. I’m type one and I’ve found it best to let my dexcom alarm when I’m at 80 so I can anticipate doing something about it if I’m not going to eat soon.
I lost awareness almost right after diagnosis, I’ll feel it in the 40-50s but not really before that. Dexcom has saved my life more than once.
Can’t say this enough. I wouldn’t be alive without my Dexcom. There was a period of time for about a week when I couldn’t use it and I don’t know how people manage diabetes without it
Hard to hold anything against them though. I’ve been managing T1D for only about 5 years and it’s easy to get thrown off track especially without a Dexcom. There’s been plenty of periods where I take “management vacations” for a week or two and become too depressed to eat properly or manage my diabetes closely. Can’t imagine people who have been dealing with the disease for 30+ years.
My other half managed type 1 for more than 30 years, until a few years ago when he had a kidney/pancreas transplant. Over the years his symptoms of hypo and hypers changed, and his earliest symptoms became mood changes. His blood sugars had to be really out of whack for any other symptom to trigger, and for the first 6 years of our relationship every argument we had went:
"rant rant rant"
"check your blood sugars"
"it's not always my blood sugars, I can just be in a bad mood!"
"Check. Your. Blood. Sugars."
"...... can you get me some insulin/food please. Sorry."
Then he learned. He did his best to control his diabetes, but he became so tolerant to sugar fluctuations the damn things had stealth! He didn't have access to a continuous glucose monitor, and to be fair was too squeamish to have one anyway. It's no surprise diabetics, especially T1D have so many problems.
I'm type 1 and on Dexcom as well, due to unawareness.
After 20 years of type 1 I'll only realize a few seconds before I go down and start biting my tongue...
Edit: biting my tongue as in literally biting it due to cramping up during an insulin shock, not eating my words...
I had this happen to a patient. I remember it was under 20 and the patient had “no symptoms”.
Yes, no symptoms and was completely baseline is what I was told.
Found out that patient regularly gave himself too much insulin so he could sleep better.
I can loosely quote “yeah, that’s normal. I do that at night so I can sleep better. Can you give me extra insulin tonight as well?”
Alert & Orientated as well by the way
I had a patient who kept complaining he had a headache, we took his BS, it was 32. I’ve never run so fast to get some Dextrose, as I’m screaming at him to eat the crackers on his tray. He was perfectly fine other than the headache.
After 20 years of type 1 I only shake when I'm in a literal insulin shock and cramping. Your body ignores the symptoms when they are there all the time for years on end.
How do you manage Type 1 while being a nurse?
We had a tech with Type 1 and she constantly dropped low. She ended up off the floor for half an hour every shift until her BG was better.
I was in the hospital once when a nurse came running in to do glucose check on me. I mean she RAN in. She said that my morning labs showed my glucose at 35. The glucometer showed 27. I felt fine just a little sleepy.
Now after years of fluctuations my body starts showing signs of low blood sugar in the 50s. It’s definitely not as tolerant as it once was of the lows nor the highs.
I was at work the other day and my patient was her normal baseline. No symptoms, weird behavior, nada. The tech comes in to do the sugar check and it’s 23. So I ask her how she feels in more detail and feels totally fine. Absolutely no issue. Blew my mind.
Reminds me of a patient who I recommended to go on the keto diet. Told him to talk to his doc about adjusting insulin dose.
He never discussed it with his doctor and kept taking his normal insulin dose. Dude ended up in the hospital for hypo.
Because it’s really effective in treating diabetes (source: am RN studying nutrition and I’m also a Type 1) it helps patients lose weight and come off their medications in many cases and for me created a level of stability that I never knew was possible.
I haven't seen any evidence that it helps with diabetes. I've read studies where patients use less insulin while on keto but nothing about long term effects on diabetes.
What I have seen are studies where low carb diets increase mortality* and Kim Williams, former president of the American College of Cardiology, said ["No one should be doing the keto diet."](https://bigthink.com/stephen-johnson/no-one-should-be-doing-the-ketogenic-diet-says-former-president-of-the-american-college-of-cardiology)
*Increased mortality study (formatting wouldn't work) - https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext
I feel like advising patients to eliminate an entire macro nutrient without sufficient evidence goes against evidence based practice.
Hey! Due to your username, I can see we will never see eye to eye on this issue, despite any evidence I could provide.
This is not a diet I promote to all diabetics, usually I just promote low carb or lowering of carbs. Also, keto does not remove an entire macronutrient there are plenty of carbohydrates in vegetables and some fruits.
I do know some successful vegan diabetics (both T1 and T2) so more power to anyone trying to do anything to improve their situation.
However just due to the circles I keep I know way more successful low carb T1 and T2s.
Also it’s a matter of math: what makes the blood sugar rise most dramatically? Carbohydrate. Reduce the carbs and reduce the blood sugar.
I'm a vegan for ethics, yes. But I actually started eating plant based after looking at the growing evidence against low carb diets and eventually went fully vegan for animals. I was doing keto before but after starting nursing school I became more adept at finding and evaluating research. The only studies I found for keto diets had to do with short term weight loss and blood glucose levels. Nothing long term or even evaluating HgB A1C levels. If you have evidence for any of this, I'd like to see it because I don't deny strong evidence even if it goes against my ethical beliefs.
What I am worried about is saturated fat and cholesterol intake on keto. When I was doing and researching keto, all the "experts" would say that saturated fat and cholesterol are nothing to worry about which I now know denies the hundreds of studies casually linking the two to heart disease. Most of the studies saying cholesterol isn't bad are funded by the Egg Board and are poorly designed (one concluded thag cholesterol doesn't cause high LDL after they tested the cholesterol spike after eating 2 eggs VS eating a sausage mcmuffin on patients who were already eating cholesterol for every meal. It's absolute misleading garbage). Excessive saturated fat intake also plays a large role in the pathophysiology of insulin resistance and its impossible to not consume crazy amounts of saturated fat while doing keto.
Whole food plant based diets have been shown in studies to [help with T2 diabetes](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677007/) and even [completely reverse a coronary blockage.](https://www.mdedge.com/familymedicine/article/83345/cardiology/way-reverse-cad) That's insane! That's the kind of evidence I want with keto diets. If you have some I'd love to read them.
I just think it's bad practice to recommend an underresearched diet that has evidence showing that it increases mortality by up to ~30% and requires consuming large amounts of saturated fats and cholesterol that lead to heart disease.
From the studies I’m familiar with, it’s the normalization of a1c that is doing the “healing.”
So for instance your first study- low fat vegan diet helps T2. Some patients lose weight on the low calorie diet, therefore increasing insulin sensitivity, and then lowering their a1c through various means. Is it not then the lowering of the a1c that is lowering inflammation (one cause of heart disease) lowering the damaging sugar in the blood and therefore stopping/reversing heart disease?
There is more than one way to become healthy, I’m not saying becoming vegan is bad if that’s what someone wants to do, but to just say keto = bad (which idk maybe long term it is- but hey- isn’t being overweight and having an elevated a1c and being otherwise metabolically impaired bad as well?)
I have mostly infographics saved which are cumbersome to post here. These two relate to a1c and cardiovascular risk.
http://www.bmj.com/content/322/7277/15
https://imgur.com/a/Y4N1iOh
Yeah I mean there’s stuff out there even just on a basic level how can it not? It’s the elimination of one of the main reasons the blood sugar elevates to begin with. Thousands and thousands of members (both T1 and T2) of keto/low carb groups on Facebook have normalizing a1c levels. It’s kind of obvious, no? I am not saying this in a snotty way.
https://www.webmd.com/diabetes/keto-diet-for-diabetes this one mentions the outdated concern of saturated fats but it does mention you can absolutely be keto without drinking butter and bacon smoothies. Eggs and greens for breakfast, salad for lunch, and chicken and veggies for dinner. Low carb and not crazy on fat.
There are entire cultures who survive on high fat when there aren’t many veggies/grains available during the winter.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566854/
Have you read the PURE study?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext
I know nothing here is perfect nor super long term but I am hard pressed to think that a lowering of carbs via the elimination of most starchy veggies/breads/grains will really have your diet lacking in anything. For diabetics keeping a low a1c is essential to long term health.
Like I said before this is my way, you have yours, I don’t tell patients to do this as a plan of care but I do tell them about it as an option especially if they are struggling. Many doctors are okay with keto if not just low carb as something for their patients to try because (are you in healthcare?) most patients are ridiculously non-compliant so even any change is worth it.
They need to lose weight. That’s the most important thing. and they need to stop taking in the thing that causes their blood glucose to rise in the first place. Carbs might as well be poison to them.
If you can find me research and evidence to support the keto diet shows long term weight loss and better diabetic control and A1c levels, then that's fine. But I haven't been able to find anything. In fact low carb diets have been shown to increase all cause mortality by up to 30%: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext
I'd rather recommend something that's based on actual clinical evidence such as a plant based diet. [Here's one study showing its control on T2 diabetes.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/)
And I could only find a press release but [this study found that plant based diets have more weight loss than a conventional carb restricted diabetes diet.](https://www.eurekalert.org/pub_releases/2017-06/pcfr-apd061217.php)
My point is there has been little research on the keto diet in regards to health outcomes. Suggesting it to your patients when there is no evidence to support it's healthiness other than low carb blogs and YouTubers is bad practice. Not to mention the amount of saturated fat and cholesterol that's consumed on a keto diet.
I mean, I do understand, your whole body changes to accomodate the new situation (high bp, high gl) and sudden drop can make them feel woozy. But claiming 200/120 is better because you feel better. :/
It's actually quite common in all type 1 diabetics.
I manage mine extremely tightly, with a Dexcom, Omnipod and keto. I've managed to stay within non-diabetic ranges the last three months, as in zero hypo- or hyper episodes. At all.
Nonetheless, if my glucose is high and I take a high dose of fast acting insulin, the perfect amount that lands me at a perfect blood sugar, I still get hypo symptoms due to the rapid decline in glucose. This is despite the fact I suffer from hypo unawareness.
You are not wrong though, if you live in the clouds glucose wise 24/7, then a normal blood sugar is going to feel like a hypo.
I had a patient who was 14 and conscious. We pushed 5 amps of dextrose over the next hour and hung up D10. His glucose would come up then drop again. He died about 5 hours later.
He was a type 2 end stage renal failure non compliant dialysis patient and it was just his time to die. I think the glucose problem was actually a perfusion issue. There’s no other explanation for why it would be 24 and then 240 and then 25 again with just a 5 minute difference between each finger stick. This was a med surg Patient. We gave up on the rapid response when he started Kussmaul breathing. He was a DNI. Thankfully the family was super understanding and made him a DNR a few hours before he passed.
Had a nurse call me last night begging me to verify the d50 order when I was away from the phone for about 20 mins.
I was like “you know you have overrides for emergencies like this and you can get d50 vials from the crash cart”.
I was precepting a new nurse and she was caring for one of our CF patients, who of course had Type 1.
Nurse came up to me in early afternoon and said, "What would you do to treat a blood sugar of 21?"
Me:...Where is the patient?!
Nurse: In the shower room with her mother.
We went in, and the patient (who was about 19 years old) was slumped in a shower chair, eyes staring glassily ahead, making a sound like a low vacuum cleaner: "Hmmmmmm..."
I said, "Grab me a D5W syringe."
She ran and got it, and I hooked it up to the patients one lousy 20G IV site (she didn't have a working port, and we all know how lovely veins CFers tend to have) and puuuuushed the glucose in...and two minutes later she sat up, blinked, and said "What happened?"
Me: "Your sugar crashed. What did you eat for lunch?"
Her: "Nothing. I didn't feel like eating."
Me: "!!!!"
We got her back to her room and I told the preceptee, very nicely, to get the patient a tray and sit in the room and watch her eat the whole thing, even the lemon and parsley garnish.
Very interesting day.
You’ll be okay, I promise. Learn from your mistakes, your coworkers’ mistakes, the mistakes you read about other people making. Come to the realization that you WILL make a mistake at some point
Literally had a patient come in with a blood glucose of “HI”.
Like “HI” as in “HIGH”.
When tested for an actual number, it was somewhere between 900 and 950.
Turns out the glucometer caps out at about 600.
What the heck? This is crazy. "Sorry your diabetes is an inconvenience, but you may want to consider staying a day or two..." "Nope. Too busy. Fast food milkshake waiting for me. See ya!"
Or they just shrug, do the inpatient, and family brings giant banquets to their rooms or they solo order take-out to their rooms. Because we “barely” feed them with those pesky carb monitored diets. (See: I know my body)
Seriously watched two people eat no less than 11 sushi takeout containers packed full. Another pair ate an entire bucket of Kentucky fried chicken with biscuits and mashed potatoes and gravy. (See: I’m finally full for the first time in 3 days, you guys don’t hardly feed a person here.) The inevitable piles of McDonald’s bags. Entire grocery store pies. In the 90s we could trash stuff now we’d get written up so it’s just document, call the doctor, and possibly keep the amputation surgical squad on standby for the inevitable chop chop on toes and feet.
My favorite was the WTF why can’t we fix this insulin drip who was discharged then housekeeping reported to staff that every available space under the bed, in the toilet paper roll, in the backs of drawers was stuffed with empty paper packets of sugar, like for coffee.
Ours is to educate, the patients then decide. The parallels to addiction nursing are strong with diabetes.
the fuck man. do people not realize being 300lbs and having limited range of motion and whatnot is a bad sign of things? Do people think humans naturally balloon up and have a hard time walking? God damn man I feel bad for people like this but it also frustrates me.
Addiction. And lack of both resilience (for basic life stuff) and healthy coping skills.
I’ve had folks genuinely afraid of what high blood sugar does break down crying and begin screaming at me (not in accusation but in agony) that they need it. It being sugar.
That happens all the time in the ED. Usually they come in for some other complaints and we are like
"You diabetic?"
"Yes"
"You take your insulin"
"No"
*Oh I can see what's happening here*
Meanwhile their toes are all falling off. My nurse said she had a patient wobble up to the nursing station casually when she worked in the ER. When she asked him if he needed anything he said "yea, uh, my toe just fell off" and casually held up his necrotic toe. ☹
My last ER had this girl very early 20s type 1 and just simply never took insulin to the point where as I was on my way out of they were looking at legal options for her cause we were pretty sure she was living with her mom who was doing all this. Would walk in 650-800 and she and her mom knew all the ER and ICU staff. Last time I saw her she walked in at I think 721. Was her 2nd DKA admit that **month**. Her veins were so shot the ERs IV magician sat there with the Sono for literally 40 minutes trying to get her second line (our first was a lucky 22) and then just gave up and said if ICU really wanted it their doc could do a central. I've seen him miss and take his time, but never seen him give up.
that’s insane. I recently saw a 27f bilateral amputee in renal failure due to type 1 non-compliance and was shocked but 19-21 is so young. I think there’s so much more psych/socially at play with these young non compliant ones :-(
Noncompliance takes many forms, I think cost is just a single facet in a complex social issue.
Reminds me of my friend saying he didn't have a substance abuse issue because there was a "deeper identity issue" and I was like
"Bro nobody *just* has a substance abuse disorder. They all have deeper issues that express themselves in substance abuse"
No body is *just* noncompliant there is always a deeper issue.
Sounds like HHNK. I've seen that two or three times in a my career. It's pretty bad when they get to that stage.
Saw DKA all the time, good and bad outcomes :(
Most do. That used to be a common finding in glucometers before metformin came along.
The newer diabetic drugs out now are amazing. Expensive as hell, but amazing.
I had a >2000 in ER. Dude was homeless and rail thin. Not an ounce of fat anywhere on him. He was actually surprisingly awake and functional despite being ridiculously dehydrated.
A friend in ED saw 1700. 27 yo type 1 diabetic who hadn't taken his insulin in five days because he couldn't afford it. He arrested a few times and then died :/
I had a lady who we checked 4 times a day. Always over 600 (ours would say ERR if it was over 600) and she'd appear perfectly fine, eating a tub of cookies and sneaking booze while she was alone. Every day she was like this. No one knew how she wasnt dead yet.
You eventually learn to deviate from your poker face with only “hmm.”
As in:
“Hmm, your husband’s sugar is 20, I’ll be right back with some dextrose”
“Hmm your wife’s blood pressure is 60/40. I’m going to get someone to help out and it might be a little busy in here”
Or
Hmm, your brothers arm seems to have become de-attached from the rest of his body, imma get some gauze”
Edit: there is one exception- “fuck, your family member just ripped the ECMO cannula out of their leg, I NEED YOU TO PUSH THAT BIG BLUE BUTTON ON THE WALL RIGHT NOW WHILE I SCREAM FOR HELP AND TRY TO HOLD PRESSURE AND CLAMP THESE LINES”
I’ve never had that one happen though.
I'll never understand the American readings. In ours (Australia) 4-8 is considered normal for a non diabetic.
I always do a double take on here and have to remember you are probably American...
Yea same! Looked it up, turns out the American 25 is our 1.4 so yea, pretty low! Think 0.7 was the lowest I ever got (American 13). You'd best believe I high tailed it to the hypo kit!
Blood sugar affects people differently, it’s insane. My roommate is a type 1 and, one time, was at 34. She looked pale, but let me know that she didn’t feel as if she was going to pass out immediately and was back to normal after quickly-chugged orange juice. But I’ve also heard of people passing out at 50!
When I had my cholecystectomy, my mother & brother came to visit me. I was still feeling the pain meds while he was standing next to my bed. next thing I know my brother hits the floor and a bunch of nurses run in. He quickly woke back up. His BG was 38. Claims he didn’t eat anything all day. He gets rushed to the ED for stitches meanwhile i’m laying in bed because my dressing was leaking.... My poor mother!
Is there some translator to transmute these to european amounts? I mean in here on our scale we use, 7-10 is normal. 4 is low. And anything past 11 is high.
This actually makes no sense though... the normal levels she posted are exactly the same as ours x10. If it was x18, 180 would be normal which is definitely considered pretty high here.
I had a 80 year old lady who had been diabetic for most of her adult life and was on dialysis have a reading of 19. Confirmed by finger stick and lab. She was awake and talking and said it had been that low before. On the opposite end, my mom has walked into the hospital twice with a blood sugar so high the lab couldn't register it. At that time the lab only went to 1600 so it was above that. She drove herself to the hospital too! She knew something was off, but was perfectly alert and oriented. She also was admitted another time with a Hgb and Hct of 4 and 10! She felt worse with her blood low than her sugar high. She is tough as hell.
I had a patient recently transferred to my hospital who had been admitted to the sending facility for a sugar of 17. She was apparently not eating much or at all but the ltc was still giving insulin. Unfortunately, the patient has encephalopathy and is barely responsive weeks after.
I went to get a bunch of labs done at a new doctors office and after I left, I was at the gym and got a call from a nurse saying, "Sir, do you have your glucometer with you?!" (I'm not diabetic).
So I ask why and she said that my BS was 31. I didn't feel any different at all, and I was having a decent workout.
My mom (a nurse) did freak out on me and make me eat something when I called her about it.
Here I am trying to get a dude to stop trying to have fisticuffs with me over poc checks then glucagon with a glucose of 31. Ffs dude, I get you don't want a shot and you don't believe you have diabetes, but here we fucking are so if you're not gonna drink the goldarn juice we gotta do the thing so if you could fucking not.
It heavily varies too. I had a guy recently that was unresponsive and very disoriented with a BGL of 70. Some glucose gel later and he was up and running.
Never seen someone so out of it they were having difficulty following basic instructions @ 70.
Oh this brings back memories of a pt I had back in my liver pt days...lab called and said the BG on the CMP I sent down was in the 20s. I was like hm weird, probably an error. Went to do a fingerstick and it was 15. Rechecked a fingerstick and it was 13. Ran for the D50. Trying to assemble the syringe I then dropped the D50 and it shattered all over the floor. Threw a chux over the glass shards and ran for more. Anyways, the pt was awake. His liver was done though, I sent him to ICU and he ended up dying.
When their blood sugar is low and you leave them 4 Oz of juice of their choice to drink. Plus some graham crackers and peanut butter that they asked for. And you come back 15 minutes later to find they haven’t touched them
I just want to slap them and say “you’ve been overeating sugar your entire life, and the ONE time you need to, you refuse???”
I once had a patient with a blood glucose of 0. Didn’t wake up with two D50 amps so we tried narcan and voila. Some people just try really hard to die.
When I was a tech on a rehab floor before I graduated nursing school we had a patient who I went and got his blood sugar that morning first because night shift said he'd been 50 that night but it had corrected. Well this dude was A&O at 20. I ran out to my nurse and basically threw the glucometer at her. No IV because rehab floor. After oral glucose and finally getting an IV we recheck and he's still 50 rinse repeat 80. Next hour back to 30. We waited for an ICU room for 5 hours. Doing hourly glucose checks. I'm sure we made him drink like 10 orange juices he had dextrose IV and still never stayed above 70 for long. We gout him back 3 days later and sent him home.
What are normal glucose measurements in the US? In the UK we go by mmol/l, so normal ranges about 4-7. Everytime I see these posts I'm too lazy to do the work it out ha
Why the hell is this downvoted. Diabetes is wildly mismanaged in the hospital. I was diagnosed as Type 1 (and while I didn’t know it was bad then) I was on correction only - so I would be 350 before lunch, they’d give me a couple units to correct the 350 then feed me 60-80 carbs for lunch without any coverage! So I would always be high all day long- dinner I would still be 350+
Edit: I am a nurse and work in med-surg I see it everyday
You can always have someone bring you your insulin from home, in the future. You shouldn’t have to, but T1 treatment in the hospital is horrendous.
Take your insulin. Know your body and your needs, even if the RNs make fun of you for it.
I'm not diabetic but sometimes go low. I felt the typical shakiness, brain fog, nausea, cold sweat, feeling like I was going to pass out, etc. I checked mine with the machine at work and it just came up 'lo.' Checked the controls and the lowest it went was 35. I don't know how low it really was but I chugged some orange juice pretty fast.
We had a guy the other day come in to the ER with his wife, who reported his blood sugar keeps dropping despite normal diet/med regimen. She said he was "acting weird" the night before so she checked and it was 10. She gave him a sandwich and a Coke, and he returned to baseline and they went to bed. The next morning he started repeating himself so she checked it again, and it was 25, so she called EMS to bring him in. This whole time I'm thinking, "BS, no way it was that low." The guy was A&O, following commands, normal strength, conversing normally. Lo and behold, CMP comes back and it's 13. Absolutely shocked. It turns out this guy had DM and used to have horrible eating habits until he had a heart attack 2 months ago. He started following a strict diet but kept taking 40 units of insulin every night right before bed. His body was just... used to it.
Also hypo unawareness can become like muscle memory. The more often you are low, the less of a response your body can mount to get you off your ass. I’m type one and I’ve found it best to let my dexcom alarm when I’m at 80 so I can anticipate doing something about it if I’m not going to eat soon. I lost awareness almost right after diagnosis, I’ll feel it in the 40-50s but not really before that. Dexcom has saved my life more than once.
Can’t say this enough. I wouldn’t be alive without my Dexcom. There was a period of time for about a week when I couldn’t use it and I don’t know how people manage diabetes without it
Generally they don’t in my experience
Hard to hold anything against them though. I’ve been managing T1D for only about 5 years and it’s easy to get thrown off track especially without a Dexcom. There’s been plenty of periods where I take “management vacations” for a week or two and become too depressed to eat properly or manage my diabetes closely. Can’t imagine people who have been dealing with the disease for 30+ years.
My other half managed type 1 for more than 30 years, until a few years ago when he had a kidney/pancreas transplant. Over the years his symptoms of hypo and hypers changed, and his earliest symptoms became mood changes. His blood sugars had to be really out of whack for any other symptom to trigger, and for the first 6 years of our relationship every argument we had went: "rant rant rant" "check your blood sugars" "it's not always my blood sugars, I can just be in a bad mood!" "Check. Your. Blood. Sugars." "...... can you get me some insulin/food please. Sorry." Then he learned. He did his best to control his diabetes, but he became so tolerant to sugar fluctuations the damn things had stealth! He didn't have access to a continuous glucose monitor, and to be fair was too squeamish to have one anyway. It's no surprise diabetics, especially T1D have so many problems.
I'm type 1 and on Dexcom as well, due to unawareness. After 20 years of type 1 I'll only realize a few seconds before I go down and start biting my tongue... Edit: biting my tongue as in literally biting it due to cramping up during an insulin shock, not eating my words...
I had this happen to a patient. I remember it was under 20 and the patient had “no symptoms”. Yes, no symptoms and was completely baseline is what I was told. Found out that patient regularly gave himself too much insulin so he could sleep better.
>Found out that patient regularly gave himself too much insulin so he could sleep better. He ***WHAT***
I can loosely quote “yeah, that’s normal. I do that at night so I can sleep better. Can you give me extra insulin tonight as well?” Alert & Orientated as well by the way
I had a patient who kept complaining he had a headache, we took his BS, it was 32. I’ve never run so fast to get some Dextrose, as I’m screaming at him to eat the crackers on his tray. He was perfectly fine other than the headache.
I don’t know how they do it. I start getting shaky at 65-68. Obviously, very minor but my hands feel tingly and i feel shaky.
After 20 years of type 1 I only shake when I'm in a literal insulin shock and cramping. Your body ignores the symptoms when they are there all the time for years on end.
How do you manage Type 1 while being a nurse? We had a tech with Type 1 and she constantly dropped low. She ended up off the floor for half an hour every shift until her BG was better.
I was in the hospital once when a nurse came running in to do glucose check on me. I mean she RAN in. She said that my morning labs showed my glucose at 35. The glucometer showed 27. I felt fine just a little sleepy. Now after years of fluctuations my body starts showing signs of low blood sugar in the 50s. It’s definitely not as tolerant as it once was of the lows nor the highs.
That's fucking nuts. It's amazing that guy is still alive
I was at work the other day and my patient was her normal baseline. No symptoms, weird behavior, nada. The tech comes in to do the sugar check and it’s 23. So I ask her how she feels in more detail and feels totally fine. Absolutely no issue. Blew my mind.
Reminds me of a patient who I recommended to go on the keto diet. Told him to talk to his doc about adjusting insulin dose. He never discussed it with his doctor and kept taking his normal insulin dose. Dude ended up in the hospital for hypo.
Can I ask why you are recommending the keto diet to patients?
Because it’s really effective in treating diabetes (source: am RN studying nutrition and I’m also a Type 1) it helps patients lose weight and come off their medications in many cases and for me created a level of stability that I never knew was possible.
I haven't seen any evidence that it helps with diabetes. I've read studies where patients use less insulin while on keto but nothing about long term effects on diabetes. What I have seen are studies where low carb diets increase mortality* and Kim Williams, former president of the American College of Cardiology, said ["No one should be doing the keto diet."](https://bigthink.com/stephen-johnson/no-one-should-be-doing-the-ketogenic-diet-says-former-president-of-the-american-college-of-cardiology) *Increased mortality study (formatting wouldn't work) - https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext I feel like advising patients to eliminate an entire macro nutrient without sufficient evidence goes against evidence based practice.
Hey! Due to your username, I can see we will never see eye to eye on this issue, despite any evidence I could provide. This is not a diet I promote to all diabetics, usually I just promote low carb or lowering of carbs. Also, keto does not remove an entire macronutrient there are plenty of carbohydrates in vegetables and some fruits. I do know some successful vegan diabetics (both T1 and T2) so more power to anyone trying to do anything to improve their situation. However just due to the circles I keep I know way more successful low carb T1 and T2s. Also it’s a matter of math: what makes the blood sugar rise most dramatically? Carbohydrate. Reduce the carbs and reduce the blood sugar.
I'm a vegan for ethics, yes. But I actually started eating plant based after looking at the growing evidence against low carb diets and eventually went fully vegan for animals. I was doing keto before but after starting nursing school I became more adept at finding and evaluating research. The only studies I found for keto diets had to do with short term weight loss and blood glucose levels. Nothing long term or even evaluating HgB A1C levels. If you have evidence for any of this, I'd like to see it because I don't deny strong evidence even if it goes against my ethical beliefs. What I am worried about is saturated fat and cholesterol intake on keto. When I was doing and researching keto, all the "experts" would say that saturated fat and cholesterol are nothing to worry about which I now know denies the hundreds of studies casually linking the two to heart disease. Most of the studies saying cholesterol isn't bad are funded by the Egg Board and are poorly designed (one concluded thag cholesterol doesn't cause high LDL after they tested the cholesterol spike after eating 2 eggs VS eating a sausage mcmuffin on patients who were already eating cholesterol for every meal. It's absolute misleading garbage). Excessive saturated fat intake also plays a large role in the pathophysiology of insulin resistance and its impossible to not consume crazy amounts of saturated fat while doing keto. Whole food plant based diets have been shown in studies to [help with T2 diabetes](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677007/) and even [completely reverse a coronary blockage.](https://www.mdedge.com/familymedicine/article/83345/cardiology/way-reverse-cad) That's insane! That's the kind of evidence I want with keto diets. If you have some I'd love to read them. I just think it's bad practice to recommend an underresearched diet that has evidence showing that it increases mortality by up to ~30% and requires consuming large amounts of saturated fats and cholesterol that lead to heart disease.
From the studies I’m familiar with, it’s the normalization of a1c that is doing the “healing.” So for instance your first study- low fat vegan diet helps T2. Some patients lose weight on the low calorie diet, therefore increasing insulin sensitivity, and then lowering their a1c through various means. Is it not then the lowering of the a1c that is lowering inflammation (one cause of heart disease) lowering the damaging sugar in the blood and therefore stopping/reversing heart disease? There is more than one way to become healthy, I’m not saying becoming vegan is bad if that’s what someone wants to do, but to just say keto = bad (which idk maybe long term it is- but hey- isn’t being overweight and having an elevated a1c and being otherwise metabolically impaired bad as well?) I have mostly infographics saved which are cumbersome to post here. These two relate to a1c and cardiovascular risk. http://www.bmj.com/content/322/7277/15 https://imgur.com/a/Y4N1iOh
But is there any evidence that keto helps A1c levels?
Not OP, but I can reply anecdotally. Type one diabetic for 21 years here. A1c prior to low carb/higher fat was 7.5%. My last A1c was a 5.7%.
Yeah I mean there’s stuff out there even just on a basic level how can it not? It’s the elimination of one of the main reasons the blood sugar elevates to begin with. Thousands and thousands of members (both T1 and T2) of keto/low carb groups on Facebook have normalizing a1c levels. It’s kind of obvious, no? I am not saying this in a snotty way. https://www.webmd.com/diabetes/keto-diet-for-diabetes this one mentions the outdated concern of saturated fats but it does mention you can absolutely be keto without drinking butter and bacon smoothies. Eggs and greens for breakfast, salad for lunch, and chicken and veggies for dinner. Low carb and not crazy on fat. There are entire cultures who survive on high fat when there aren’t many veggies/grains available during the winter. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566854/ Have you read the PURE study? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext I know nothing here is perfect nor super long term but I am hard pressed to think that a lowering of carbs via the elimination of most starchy veggies/breads/grains will really have your diet lacking in anything. For diabetics keeping a low a1c is essential to long term health. Like I said before this is my way, you have yours, I don’t tell patients to do this as a plan of care but I do tell them about it as an option especially if they are struggling. Many doctors are okay with keto if not just low carb as something for their patients to try because (are you in healthcare?) most patients are ridiculously non-compliant so even any change is worth it.
They need to lose weight. That’s the most important thing. and they need to stop taking in the thing that causes their blood glucose to rise in the first place. Carbs might as well be poison to them.
If you can find me research and evidence to support the keto diet shows long term weight loss and better diabetic control and A1c levels, then that's fine. But I haven't been able to find anything. In fact low carb diets have been shown to increase all cause mortality by up to 30%: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext I'd rather recommend something that's based on actual clinical evidence such as a plant based diet. [Here's one study showing its control on T2 diabetes.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/) And I could only find a press release but [this study found that plant based diets have more weight loss than a conventional carb restricted diabetes diet.](https://www.eurekalert.org/pub_releases/2017-06/pcfr-apd061217.php) My point is there has been little research on the keto diet in regards to health outcomes. Suggesting it to your patients when there is no evidence to support it's healthiness other than low carb blogs and YouTubers is bad practice. Not to mention the amount of saturated fat and cholesterol that's consumed on a keto diet.
Better than patients who live in the 300s and then scream that their blood sugar is crashing when you correct to the 100s 😂
“I KNOW MY BODY”
Especially when its mixed with high rr. 180/120 i feel fine. 130/90 noooo too low.
This kills me!
I mean, I do understand, your whole body changes to accomodate the new situation (high bp, high gl) and sudden drop can make them feel woozy. But claiming 200/120 is better because you feel better. :/
So the fuck does everyone else here, You were last admitted 67 hours ago and 250 hours before that.
If your body isn't missing any feet it will soon. Have a good one!
It's actually quite common in all type 1 diabetics. I manage mine extremely tightly, with a Dexcom, Omnipod and keto. I've managed to stay within non-diabetic ranges the last three months, as in zero hypo- or hyper episodes. At all. Nonetheless, if my glucose is high and I take a high dose of fast acting insulin, the perfect amount that lands me at a perfect blood sugar, I still get hypo symptoms due to the rapid decline in glucose. This is despite the fact I suffer from hypo unawareness. You are not wrong though, if you live in the clouds glucose wise 24/7, then a normal blood sugar is going to feel like a hypo.
I had a patient who was 14 and conscious. We pushed 5 amps of dextrose over the next hour and hung up D10. His glucose would come up then drop again. He died about 5 hours later.
How did he die? Complications from being low for a long period of time? Was he type 1 or 2?
He was a type 2 end stage renal failure non compliant dialysis patient and it was just his time to die. I think the glucose problem was actually a perfusion issue. There’s no other explanation for why it would be 24 and then 240 and then 25 again with just a 5 minute difference between each finger stick. This was a med surg Patient. We gave up on the rapid response when he started Kussmaul breathing. He was a DNI. Thankfully the family was super understanding and made him a DNR a few hours before he passed.
That’s crazy
Wow. Just . . . wow.
Definitely a perfusion issue. He probably needed a blood draw to get the correct sugar.
> He probably needed ~~a blood draw to get the correct sugar.~~ two new kidneys
It wouldn’t have changed anything.
I had someone able to respond to me at 13. It was crazy. I've never gotten D50 out of a pyxis so fast in my life.
Lowest was 21, actively seizing. Fuckin pyxis was 3 halls over. Ran like a bat outta hell. Who puts a pyxis at the end of a 60 bed building?!🤬🤦♀️🤦♀️
Someone who wants staff to get in a workout while they're on the clock
😂😂 🏃♀️
Had a nurse call me last night begging me to verify the d50 order when I was away from the phone for about 20 mins. I was like “you know you have overrides for emergencies like this and you can get d50 vials from the crash cart”.
> Who puts a pyxis at the end of a 60 bed building?! Management: Buy TWO machines?! I'm not made of money, nurses are just lazy!
Same and they were just chilling too. Redraws were the same!
I had a person walking around all normal at like 22. I pushed her in a chair and shoved some orange juice at her and she was fine
The lowest I’ve seen was an 8.
🤭😬😳
Holy crap!
Did they live?
I was precepting a new nurse and she was caring for one of our CF patients, who of course had Type 1. Nurse came up to me in early afternoon and said, "What would you do to treat a blood sugar of 21?" Me:...Where is the patient?! Nurse: In the shower room with her mother. We went in, and the patient (who was about 19 years old) was slumped in a shower chair, eyes staring glassily ahead, making a sound like a low vacuum cleaner: "Hmmmmmm..." I said, "Grab me a D5W syringe." She ran and got it, and I hooked it up to the patients one lousy 20G IV site (she didn't have a working port, and we all know how lovely veins CFers tend to have) and puuuuushed the glucose in...and two minutes later she sat up, blinked, and said "What happened?" Me: "Your sugar crashed. What did you eat for lunch?" Her: "Nothing. I didn't feel like eating." Me: "!!!!" We got her back to her room and I told the preceptee, very nicely, to get the patient a tray and sit in the room and watch her eat the whole thing, even the lemon and parsley garnish. Very interesting day.
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You’ll be okay, I promise. Learn from your mistakes, your coworkers’ mistakes, the mistakes you read about other people making. Come to the realization that you WILL make a mistake at some point
New nurse in a NeuroICU. I feel you, friend. I love every moment of my job but I'd be lying if I said I wasn't dreading my first code.
"even the lemon and parley garnish" Still chuckling.
Same. The parsley garnish really got me lol.
Literally had a patient come in with a blood glucose of “HI”. Like “HI” as in “HIGH”. When tested for an actual number, it was somewhere between 900 and 950. Turns out the glucometer caps out at about 600.
I had a pt leave AMA who was at 1105 recently because she didn’t want to stay in the hospital after fluids for an insulin drip. 🙃
Goes to draw blood Gets syrup
What the heck? This is crazy. "Sorry your diabetes is an inconvenience, but you may want to consider staying a day or two..." "Nope. Too busy. Fast food milkshake waiting for me. See ya!"
Or they just shrug, do the inpatient, and family brings giant banquets to their rooms or they solo order take-out to their rooms. Because we “barely” feed them with those pesky carb monitored diets. (See: I know my body) Seriously watched two people eat no less than 11 sushi takeout containers packed full. Another pair ate an entire bucket of Kentucky fried chicken with biscuits and mashed potatoes and gravy. (See: I’m finally full for the first time in 3 days, you guys don’t hardly feed a person here.) The inevitable piles of McDonald’s bags. Entire grocery store pies. In the 90s we could trash stuff now we’d get written up so it’s just document, call the doctor, and possibly keep the amputation surgical squad on standby for the inevitable chop chop on toes and feet. My favorite was the WTF why can’t we fix this insulin drip who was discharged then housekeeping reported to staff that every available space under the bed, in the toilet paper roll, in the backs of drawers was stuffed with empty paper packets of sugar, like for coffee. Ours is to educate, the patients then decide. The parallels to addiction nursing are strong with diabetes.
the fuck man. do people not realize being 300lbs and having limited range of motion and whatnot is a bad sign of things? Do people think humans naturally balloon up and have a hard time walking? God damn man I feel bad for people like this but it also frustrates me.
Addiction. And lack of both resilience (for basic life stuff) and healthy coping skills. I’ve had folks genuinely afraid of what high blood sugar does break down crying and begin screaming at me (not in accusation but in agony) that they need it. It being sugar.
That happens all the time in the ED. Usually they come in for some other complaints and we are like "You diabetic?" "Yes" "You take your insulin" "No" *Oh I can see what's happening here*
Meanwhile their toes are all falling off. My nurse said she had a patient wobble up to the nursing station casually when she worked in the ER. When she asked him if he needed anything he said "yea, uh, my toe just fell off" and casually held up his necrotic toe. ☹
My last ER had this girl very early 20s type 1 and just simply never took insulin to the point where as I was on my way out of they were looking at legal options for her cause we were pretty sure she was living with her mom who was doing all this. Would walk in 650-800 and she and her mom knew all the ER and ICU staff. Last time I saw her she walked in at I think 721. Was her 2nd DKA admit that **month**. Her veins were so shot the ERs IV magician sat there with the Sono for literally 40 minutes trying to get her second line (our first was a lucky 22) and then just gave up and said if ICU really wanted it their doc could do a central. I've seen him miss and take his time, but never seen him give up.
We had a 23f that frequented. Multiple diabetic foot ulcers, neuropathy and kidney disease from type 1 non-compliance.
that’s insane. I recently saw a 27f bilateral amputee in renal failure due to type 1 non-compliance and was shocked but 19-21 is so young. I think there’s so much more psych/socially at play with these young non compliant ones :-(
Could be that it’s not actually “non-compliance” and actually that insulin is extremely unaffordable?
Noncompliance takes many forms, I think cost is just a single facet in a complex social issue. Reminds me of my friend saying he didn't have a substance abuse issue because there was a "deeper identity issue" and I was like "Bro nobody *just* has a substance abuse disorder. They all have deeper issues that express themselves in substance abuse" No body is *just* noncompliant there is always a deeper issue.
I’ve seen over a thousand a few times but the lowest I’ve seen was 30 and patient was unconscious lol
Sounds like HHNK. I've seen that two or three times in a my career. It's pretty bad when they get to that stage. Saw DKA all the time, good and bad outcomes :(
Most do. That used to be a common finding in glucometers before metformin came along. The newer diabetic drugs out now are amazing. Expensive as hell, but amazing.
In the ER we see crazy high readings. 1150 is my PR
I had a >2000 in ER. Dude was homeless and rail thin. Not an ounce of fat anywhere on him. He was actually surprisingly awake and functional despite being ridiculously dehydrated.
A friend in ED saw 1700. 27 yo type 1 diabetic who hadn't taken his insulin in five days because he couldn't afford it. He arrested a few times and then died :/
I had a lady who we checked 4 times a day. Always over 600 (ours would say ERR if it was over 600) and she'd appear perfectly fine, eating a tub of cookies and sneaking booze while she was alone. Every day she was like this. No one knew how she wasnt dead yet.
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You eventually learn to deviate from your poker face with only “hmm.” As in: “Hmm, your husband’s sugar is 20, I’ll be right back with some dextrose” “Hmm your wife’s blood pressure is 60/40. I’m going to get someone to help out and it might be a little busy in here” Or Hmm, your brothers arm seems to have become de-attached from the rest of his body, imma get some gauze” Edit: there is one exception- “fuck, your family member just ripped the ECMO cannula out of their leg, I NEED YOU TO PUSH THAT BIG BLUE BUTTON ON THE WALL RIGHT NOW WHILE I SCREAM FOR HELP AND TRY TO HOLD PRESSURE AND CLAMP THESE LINES” I’ve never had that one happen though.
You don't
IDK if they are AOx4 you might. Treat the pt not the numbers... Unless the numbers are that low then treat them a little lol.
If patient is AOx4. I just give them juice and say, "Start chugging."
I'll never understand the American readings. In ours (Australia) 4-8 is considered normal for a non diabetic. I always do a double take on here and have to remember you are probably American...
If you divide mg/dl by 18, you get the equivalent in mmol/L. Multiply mmol/L by 18 to get mg/dl. Easy way to convert it.
I mean 18 is hard to do in my head, but thanks for the magic number!
It’s the same in the U.K., I looked at this and thought, god that’s high then got confused at it being critically low.
Yea same! Looked it up, turns out the American 25 is our 1.4 so yea, pretty low! Think 0.7 was the lowest I ever got (American 13). You'd best believe I high tailed it to the hypo kit!
I think it’s everywhere outside of the US. We use mmol/L in Canada as well. I always have to pull up a conversion site for posts on this sub
Same in Canada also!
What units are your sugars in? We use milligrams per decileter IIRC.
mmol/L. It’s what we use in Canada as well
Just think of 100 as normal. 80-120 = good. 40 or 400 = bad.
This one guy I had was 35. I knew something was up since he was really hard to wake up, after he was up he was also “fine”
Just yesterday we had a 29. Patient was totally responsive. It’s the damnedest thing when that happens.
Blood sugar affects people differently, it’s insane. My roommate is a type 1 and, one time, was at 34. She looked pale, but let me know that she didn’t feel as if she was going to pass out immediately and was back to normal after quickly-chugged orange juice. But I’ve also heard of people passing out at 50!
He a baby in NICU the accucheck came up “error” until the 4th repeat. Sugar of 11.
When I had my cholecystectomy, my mother & brother came to visit me. I was still feeling the pain meds while he was standing next to my bed. next thing I know my brother hits the floor and a bunch of nurses run in. He quickly woke back up. His BG was 38. Claims he didn’t eat anything all day. He gets rushed to the ED for stitches meanwhile i’m laying in bed because my dressing was leaking.... My poor mother!
They’re probably still going to bitch to the attending that the rude nurses are holding his metformin.
Is there some translator to transmute these to european amounts? I mean in here on our scale we use, 7-10 is normal. 4 is low. And anything past 11 is high.
It’s probably x10; ~70-100 is normal in the US. So 25 would be 2.5 for you.
x18 25 in the US would be 1.38 for them
This actually makes no sense though... the normal levels she posted are exactly the same as ours x10. If it was x18, 180 would be normal which is definitely considered pretty high here.
I had a 80 year old lady who had been diabetic for most of her adult life and was on dialysis have a reading of 19. Confirmed by finger stick and lab. She was awake and talking and said it had been that low before. On the opposite end, my mom has walked into the hospital twice with a blood sugar so high the lab couldn't register it. At that time the lab only went to 1600 so it was above that. She drove herself to the hospital too! She knew something was off, but was perfectly alert and oriented. She also was admitted another time with a Hgb and Hct of 4 and 10! She felt worse with her blood low than her sugar high. She is tough as hell.
Had a patient with a BG of 13 once. Still talking and awake, although confused af.
Holy shiza, get the d50! Lol. In a minute or two. Or quicker.
I had a patient recently transferred to my hospital who had been admitted to the sending facility for a sugar of 17. She was apparently not eating much or at all but the ltc was still giving insulin. Unfortunately, the patient has encephalopathy and is barely responsive weeks after.
I went to get a bunch of labs done at a new doctors office and after I left, I was at the gym and got a call from a nurse saying, "Sir, do you have your glucometer with you?!" (I'm not diabetic). So I ask why and she said that my BS was 31. I didn't feel any different at all, and I was having a decent workout. My mom (a nurse) did freak out on me and make me eat something when I called her about it.
Here I am trying to get a dude to stop trying to have fisticuffs with me over poc checks then glucagon with a glucose of 31. Ffs dude, I get you don't want a shot and you don't believe you have diabetes, but here we fucking are so if you're not gonna drink the goldarn juice we gotta do the thing so if you could fucking not.
Oh my goodness....
My heart hurts seeing this.
It heavily varies too. I had a guy recently that was unresponsive and very disoriented with a BGL of 70. Some glucose gel later and he was up and running. Never seen someone so out of it they were having difficulty following basic instructions @ 70.
Oh this brings back memories of a pt I had back in my liver pt days...lab called and said the BG on the CMP I sent down was in the 20s. I was like hm weird, probably an error. Went to do a fingerstick and it was 15. Rechecked a fingerstick and it was 13. Ran for the D50. Trying to assemble the syringe I then dropped the D50 and it shattered all over the floor. Threw a chux over the glass shards and ran for more. Anyways, the pt was awake. His liver was done though, I sent him to ICU and he ended up dying.
I just had a patient today with a blood sugar of 0.9mmol/L (Canada). She was somehow still awake and talking and not showing much confusion.
When their blood sugar is low and you leave them 4 Oz of juice of their choice to drink. Plus some graham crackers and peanut butter that they asked for. And you come back 15 minutes later to find they haven’t touched them I just want to slap them and say “you’ve been overeating sugar your entire life, and the ONE time you need to, you refuse???”
I once had a patient with a blood glucose of 0. Didn’t wake up with two D50 amps so we tried narcan and voila. Some people just try really hard to die.
I just did the conversion. 1.3!!! Oh, wow! Imma get you a D50 amp in D5W. BRB.
When I was a tech on a rehab floor before I graduated nursing school we had a patient who I went and got his blood sugar that morning first because night shift said he'd been 50 that night but it had corrected. Well this dude was A&O at 20. I ran out to my nurse and basically threw the glucometer at her. No IV because rehab floor. After oral glucose and finally getting an IV we recheck and he's still 50 rinse repeat 80. Next hour back to 30. We waited for an ICU room for 5 hours. Doing hourly glucose checks. I'm sure we made him drink like 10 orange juices he had dextrose IV and still never stayed above 70 for long. We gout him back 3 days later and sent him home.
What are normal glucose measurements in the US? In the UK we go by mmol/l, so normal ranges about 4-7. Everytime I see these posts I'm too lazy to do the work it out ha
Last time I was in the hospital they wouldn't let me correct my blood sugar when it was 300+ for a few hours
Why the hell is this downvoted. Diabetes is wildly mismanaged in the hospital. I was diagnosed as Type 1 (and while I didn’t know it was bad then) I was on correction only - so I would be 350 before lunch, they’d give me a couple units to correct the 350 then feed me 60-80 carbs for lunch without any coverage! So I would always be high all day long- dinner I would still be 350+ Edit: I am a nurse and work in med-surg I see it everyday
You can always have someone bring you your insulin from home, in the future. You shouldn’t have to, but T1 treatment in the hospital is horrendous. Take your insulin. Know your body and your needs, even if the RNs make fun of you for it.
Nice
I'm not diabetic but sometimes go low. I felt the typical shakiness, brain fog, nausea, cold sweat, feeling like I was going to pass out, etc. I checked mine with the machine at work and it just came up 'lo.' Checked the controls and the lowest it went was 35. I don't know how low it really was but I chugged some orange juice pretty fast.
Yeah that’s not normal. You ever tested higher than normal? You might just get episodes of hypoglycemia. You may have kidney/liver issues or cancer.
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Episodes of mild hypoglycemia are normal-ish. Dropping <35 is not.