As some of you may know, I work as an RN in an intensive care unit. I am currently in the team leader/ charge nurse position. As part of this, I attend morning rounds on each of the patients in the ICU. My role during this is to act as a patient, family and nurse advocate.
We do morning rounds outside the patient room huddled around the patient’s nurse. There is a big group of us including the internist (physician, or our “rural” form of intensivist), pharmacist, dietician, nurse specialists, nurse manager etc. Recently, during patient rounds, we started with an older lady admitted with respiratory (breathing) issues. Diabetes happened to be part of her medical history, and her blood glucose during her admission had been a bit of a rollercoaster act: 2.3mmol/L one morning, 27.3 the next and so on. So, the physician adjusts the insulin order set accordingly, and we hit the patient with insulin or Dextrose IV as required.
On this particular morning, when the patient’s primary nurse told the physician the blood glucose was 27.3mmol/L the physician sighed and said “She is a very...,” and she paused, at which point I interjected and said “OH NO, don’t say it,” and she concluded her statement with “...brittle diabetic.” Ahhhh “brittle diabetic” -a term that sounds like nails down a chalkboard to me.
Is it really necessary to label each diabetic? Let’s NOT simply hit them with “brittle diabetic” label, which gets us nowhere. I feel like once a person has been called a brittle diabetic, then it tends to stick with them. Health care professionals may even think “Oh, looks like her sugars are up and down again, she is just so brittle ya’ll!” The patient may walk away thinking “I am just so brittle ya’ll, that’s why I can’t seem to get my blood glucose stable.” Then the patient comes back for a follow-up appointment, and is this time labelled non-compliant. Could it be that the patient went home feeling helpless and lost because after being called “brittle” he or she feels that no matter what they do their sugar is going to swing anyway?
My point is that I believe there is NO such thing as a brittle diabetic. These “brittle diabetics” are people who do not have, or who have not been offered, the resources and education about how to care for their diabetes properly. Yes, they may also be the person who is at a point in their life in which they do not take the time to manage their diabetes, aka the “non-compliant” diabetic, but there must be a reason behind it. We need to remember that there is a mix of these people. As an RN, I so often see how the Determinants of Health (socioeconomic status, physical environment, and personal behaviours and characteristics) come into play with each of my patients, including those with diabetes.
No, we may not be able to change a person’s socioeconomic status. Yes, it is extremely difficult to change behaviours and personal characteristics. What we CAN do is adjust the physical environment. Be proactive, and positive. Don’t set someone up for “failure” by calling them a brittle diabetic. Eeek, even typing the term makes me cringe.
What do YOU think?
Have you ever been annoyed with the term brittle diabetes?
SIDENOTES
-I'm so pumped I know how to make paragraphs now
-I hope you all don't mind I described blood glucose in mmol/L form. Many of you probably convert to mg/dL in your head, otherwise I know there are nice little conversion calculators all over the web.
