As an RN for 10 years in the summer of 1995, I knew the symptoms of diabetes. I had them all. And I ignored them. I peed a lot, couldn’t get enough to drink (non-alcoholic, thank you), was losing weight (a good thing), and had times when my vision was so blurred that I couldn’t differentiate the words on a page- it was all just gray blur. I figured it was just because of a recent diet change (to lose weight), and I’d be fine. *palm forehead*
I started (or restarted) a job at a community hospital in the Texas Hill Country. It was their practice to do a urinalysis, drug test, back x-rays, and have one of the ER docs do a viability check once the offer of employment tentatively had been made (adjusted if anything came back on the back x-rays, or drug test in particular). I’d worked there before; I knew the drill. I got a message to go talk to the employee health nurse. That was odd. I knew Patsy (pseudonym) and she didn’t just call people to her office to chat. She had something to tell me.
I got to her office, and she was her usual friendly self, but had a look of ‘this is business’ on her face. She had me sit down across from her desk, and handed me my urinalysis. She asked me if I saw anything wrong. It was glaring. There should be no glucose in urine. I had a level over 2000. There was only one logical deduction. I had diabetes. I just looked up and started bawling.
She told me they’d get me into the diabetic teaching classes; being a nurse taking care of someone was way different than having the disease (boy, she wasn’t kidding). She’d get me in contact with Charlene (not her real name, either), the in-house diabetic support person (who also taught the classes). And, they’d get me an appointment with a family practice doctor to get this all seen and verified with fasting lab work. My random fingerstick was 389mg/dl- with no symptoms, and on a basic, ordinary day. Not good.
I saw the doctor, who ordered a fasting blood sugar (240mg/dl) and A1C- 10.2 (should be below 6 for a non-diabetic, and ideally below 7 for a diabetic). She didn’t want to start insulin until a trial of diet and exercise was done. She also didn’t want to start any oral diabetic meds. I was fine with that. I did well on diet and exercise- and before long had my blood sugars in the normal range for a non-diabetic.
I went to the classes and learned a LOT. Charlene was a major advocate for diabetics, and knew a lot from having a diabetic son. She had invaluable information. She taught the day to day living stuff. As a nurse, I knew the clinical stuff. There’s a huge difference.
I’d been taught the signs and symptoms of low blood sugars in school, and one of my supervisors would go running for a half of a pimento cheese sandwich if I ever said I felt tired, edgy, shaky, had a headache, or felt my heart racing (never mind I’d be running around all over the hospital floor where I was the charge RN- and ONLY RN on an acute surgical floor w/heavy ortho). She was taking NO chances 🙂 Never mind that the sandwich would have only been good after a carb source, as protein and fat slow the carbs from raising the blood sugar. Not horrible if it’s a ‘high’ low, but if it’s a ‘low’ low, it could be real trouble. I also had been running such high blood sugars that a 150 would have me trembling and sweating- took time for my body to adjust. Fortunately, insurance had just started covering monitors and test strips for Type 2 diabetics.
I lost weight to the tune of about 100 pounds total, from the weight loss before being diagnosed, and then by not so healthy ways when I tried to lose weight after being diagnosed (focusing on food and weight loss had been an additional factor in relapsing into eating disorders about 5 months later). My blood sugars were normal nearly all of the time. A1C dropped to 5.2.
I want to emphasize that this didn’t mean I was no longer diabetic. I was in control of the diabetes. There’s a huge difference. I still had to monitor my blood sugars (though not as often), and let doctors know I was diabetic if I had to have any medical testing done. I couldn’t go back to my pre-diagnosis state, and just ignore that it was there. I did have episodic lows, which isn’t that common, but can happen in type IIs not on medication.
It took 12 years before I needed to start medication. That pill made my stomach a mess initially. I started insulin later in 2007 ( a few months after the common pill) , and that was the best thing ever for my blood sugar control. It was some work initially to figure out the dosage of the long-acting ‘basal’ insulin (Lantus for me), and the rapid acting (NovoLog) for before meals. I had to do a lot of testing before and after meals to get the right ratio down, and I found that the more tightly I calculated my carbohydrates, the more flexibility I actually had. Things were going well until I was diagnosed with leukemia, and have had bizarre blood sugars on, and now off, chemo. I’m still working on getting it back to a reasonable level. It gets frustrating.
I’m a stickler for numbers. When I saw my AIC going up prior to starting insulin, I wanted something done. I didn’t want to wait until it got into the ‘bad’ range. I saw no reason not to be proactive, and waiting around for bad numbers made me mad. The endocrinologist I saw was dragging her feet so I talked to my Coumadin nurse (a nurse practitioner) who had no problem starting me on Lantus. My numbers almost immediately got better. I had to be my own advocate. The fired endocrinologist wasn’t doing anything productive.
I also learned that having diabetes is so different than taking care of patients with diabetes as a nurse. There is no connection. Those sliding scale doses of insulin are useless unless they are very specific for the specific patient’s numbers. If I didn’t tell the doctors and nurses I have my ratios figured out, I would have gotten some ridiculously low dose when in the hospital. I had to speak up. I also know what foods make my blood sugars weird- they’re different for each person. I know to have proteins and/or fat with carbs to level things out. Some emergency room folks here don’t have a clue about that when treating lows, and put me in danger. There was a lot to learn, and in the process I learned to look at each diabetic person I took care of as what they were- an individual.
Now, just to get things back to normal after chemo…that was a game changer. I’m cured of APL, but my sugars have been wonky for a decade now. (edit)