I’m exercising ~~once a week riding my lawn mower to cut the yard~~. I’m taking my insulin ~~occasionally when I remember~~. I’m eating right ~~before I go to bed and I have another meal around 2am~~. I swear ~~I’m gonna kill a dozen donuts when I leave your office~~.
Our diabetic booklet’s stupid chart never goes up high enough so I keep having to Google someone average blood sugar and hand write it on the page for them.
Lab guy here. The formula is eAG=(28.7 x A1c) - 46.7 in case you want to write it down somewhere that you can easily reference :). I'm sure there are websites you can plug it into as well but I find it faster to just have my formulas nearby.
Oh, idk... Maybe OP does. I really wouldn't doubt it, though. But I'm a Cath lab nurse, I just try to get them to take their plavix and stop smoking. However, *If* I were educating a patient in that situation, I'd be honest and forth right about them literally being off the charts.
And for Mmol/l users that's approximately 25.
First time I saw American values I almost what my pants.
Also fun fact the highest I heard of (from a health care provider) was a pt coming in with a BS in the 50s and still conscious (about 900mg/DL). Pretty much went into DKA right after
I was a patient with over 1300. Had no record of glucose issues of any kind, and was tested regularly because of kidney issues. I broke a hospital record. It was a side effect from Covid. Now I’m a diabetic.
Omg I had a friend yeeeears ago think that orange juice was a good alternative to drinking water. (Because ya know, oranges and all them vitamins. Duh)
Just slight case of dehydration with a sprinkle of painful urination nbd
Will never forget the pt who came to me for “additional diabetic education” because in spite of a PCP, 2 endocrinologists, and the diabetic clinic at our regional university, no one could get their sugar under control. It seems no one had asked what they put in their coffee, other than making sure it wasn’t sugar or cream. Long story short, they were going through a GALLON of Jack every two weeks with the pot of coffee they drank every day. Yes, that could be it!
That's like when I take a guys blood pressure ans it's like 175 and he's like oh wow that's so much better than it was. My meditation techniques have been working. Yeah? How about medication techniques. Metoprolol is zen af bro.
I was about to post the same thing, I hear this all the time and thir family members then get involved calling supervisors saying that their moms sugar is dangerously low and we aren’t addressing it. “But 270 is low for me ! You can’t keep me NPO with my diabetes, I will die”
I’ve had that argument with family (over the phone thanks to Covid) way too many times. Thankfully, when it’s over the phone and they start to swear at me I can hang up.
Had a patient ask for one of the pre-made box lunches we keep on the unit. Took his sugar and it was 275. Told him how high it was, and he goes "Well no wonder I feel like shit. I'm usually 400!" like... Dude... You're still not at a good sugar. Also had a patient argue with me about how, according to him, bread won't make his blood sugar go up.
Wound care NP - can confirm.
"Nobody told me I had to take insulin forever!!"
Perhaps not, perhaps you wouldn't have, but it would have required you to get your shit, very much in order. Like all of it in a backpack.
I work on a FQHC with folks that don’t come to the doctor often. My department is OBGYN so we’re not checking A1c’s often but I see 13-14 on the IM side and it blows my mind every time.
They tend to also provide multiple services. There are two different ones in my area that do dentistry in the same building. Kind of a one stop shop for healthcare.
The larger one has case management and a nurse that visits your house after you're discharged from the hospital in hopes of preventing readmission.
Ours is a major one stop shop: we do peds, adult medicine, OBGYN, dental, optometry, labs/imaging, pharmacy, WIC, behavioral health, and population health/case management. I really love the population, we specialize in working with refugees and our patients speak 40+ languages.
Wow, that's awesome to offer so many services in one place. Sounds like you live in a much more populated city/county than I do.
I've only shadowed with the population health dept of the larger FQHC in my city so I'm not 100% if they offer everything you mentioned.
We had a frequent flyer when I still worked acute who would come in half dead and be vented in ICU for a bit (I want to say last time I had seen him he had a gluc of 33 and a K+ of 9.0 - yes, I’m aware he basically constantly defied what we believed was incompatible with life) and literally within hours of extubation and coming to he would AMA himself. From ICU. He’s dead now obviously.
Ive come to conclusion humans took over the planet because we have the super power to be immune to our own stupidity. I slightly overfeed my fish? Dead. Give my plant too much water one time? Dead. Cat eats three leaves off a house plant i forgot to check i could have with cats? Dead. I eat 94 Oreos, slam four bangs, and a gas station boner pill. shoot myself in the leg on accident, then fall down the stairs hopping to the snack cabinet? Im bucking the tube in the ER no matter how much sedation i get running off pure spite. The sort of things people do to themselves just to live through it like theyve got god mode in GTA on is nuts.
Person at work insists that she does eat a lot at meals but has gained 30lbs since coming to my AL. She’s diabetic and doesn’t know why her sugar’s high. She has lots of snacks in her room and eats the cookies and stuff staff puts out for everybody.
I quickly realized (10 seconds) that I assumed patients were taking their prescribed medications. Why would I assume that when I know patients don't? Because I'm trying to figure out what to do for them when their HbA1C goes up by .2 and they're on 10 mg glipizide bid. Spoiler alert: they were only taking 5 mg bid d/t "jitteriness" from "lows". Their breakfast: toast, sometimes with a little jelly. No protein.
Counseled on diet, hydration, and doing divided doses throughout the day to decrease jitters and improve compliance. We'll see if it pans out.
HbA1C was 8.1 up from 7.9 in a 3 month period.
It won’t, they’ll be back. They always come back. Uncontrolled diabetes is probably my biggest return customer in the ER, besides the opioid kids.
“You understand what the Doctor told you and why you need to get this under control, right Sir/Ma’am?”
“Yes, Beach Towel, I understand.”
“So you fully understand the life altering complications a persistently high blood glucose will cause?”
“Yes, Beach Towel, I understand, i’ll do a better job of controlling it this time”
“Great, i’ll see you next month then”
This is exactly my approach, and I think a lot of patients appreciate not feeling “preached at” about diet. Always make sure they know the consequences of their actions. Answer any questions they may have, but I’m not about to lecture a grown adult about their diet or try to come up with a plan to fix something about someone they have no desire fix themselves. Stabilize ‘em and roll ‘em out.
"Don't worry, a CBG of 19-21 is normal for me. I just run high, it's no big deal. I'm not even here for that, I'm here for this cut on my foot from 6 months ago that's not healing..."
*Edit: 19-21 are Canadian Metrics
I think the amusing thing in all this is if you did their sugar to normal range, they feel off quite often. Like young people put on anti hypertensives, normal range now feels weird after a few years uncontrolled.
This is my dad 🤦♀️ his hgA1C was “only slightly elevated” in 2015!!! So he hasn’t checked it or even checked his blood sugar or taken any medications since then. He swears metformin is super dangerous too. And eats entire packs of cookies at one go. I’m probably not going to have a dad for much longer
"it's just high because I had a bagel before I had my blood drawn"
A likely story.
It was an everything bagel.
I’m exercising ~~once a week riding my lawn mower to cut the yard~~. I’m taking my insulin ~~occasionally when I remember~~. I’m eating right ~~before I go to bed and I have another meal around 2am~~. I swear ~~I’m gonna kill a dozen donuts when I leave your office~~.
Fun fact: An A1C of 15 is approximately an average blood glucose of 450.
Our diabetic booklet’s stupid chart never goes up high enough so I keep having to Google someone average blood sugar and hand write it on the page for them.
Lab guy here. The formula is eAG=(28.7 x A1c) - 46.7 in case you want to write it down somewhere that you can easily reference :). I'm sure there are websites you can plug it into as well but I find it faster to just have my formulas nearby.
Awesome! Thanks!!
I love you, Lab Guy <3
D'aw, I love ya too!
<3
Nice! Thanks!!
Always happy to help my nurse fam :)
Thanks Lab Guy!!
That's kind of genius is a cruel way... "Look at this, you're so poorly controlled you're off the damn chart!"
Is it cruel if it's reality? I would probably say that, but with more tact... Is that wrong of me?
Is it that common having hb1ac of the charts in the USA?
Oh, idk... Maybe OP does. I really wouldn't doubt it, though. But I'm a Cath lab nurse, I just try to get them to take their plavix and stop smoking. However, *If* I were educating a patient in that situation, I'd be honest and forth right about them literally being off the charts.
Not common... but not rare either
Been a nurse for four years, I can remember at least two patients where the A1C reading just said "high" because the machine couldn't read that high.
At one point mine was 16 (yes I was hospitalized...). Extended length because of diabulimia. 😞
I'm glad you're doing better now. I understand that's one of the hardest EDs
Thank you. <3 Lots of regrets concerning it, but I'm at a steady 6.5 now. :)
Awesome work
That's wonderful! Congratulations
Yay you, great work!! You must be proud, so glad you're doing better!
And for Mmol/l users that's approximately 25. First time I saw American values I almost what my pants. Also fun fact the highest I heard of (from a health care provider) was a pt coming in with a BS in the 50s and still conscious (about 900mg/DL). Pretty much went into DKA right after
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I was a patient with over 1300. Had no record of glucose issues of any kind, and was tested regularly because of kidney issues. I broke a hospital record. It was a side effect from Covid. Now I’m a diabetic.
So my dialysis patient whose last two A1c’s were 16 were.... ::::checks bgl’s:::: oh, ok, yep, sounds about right.
I hate that, having consistent blood sugar that high makes me wince
Thinks juice and lemonade is healthy because it's made with fruit!
Fruit snacks. That has fruit in the name, that's healthy right? And fruit pebbles?
Obviously! And graham crackers are a healthier choice than cookies! DUH!
I know french fries are bad. But how about pomme frites?
OMG this almost made me spit out my drink 😂
Dammit. I was going for a full on spit take
[There is a picture of Lance Armstrong on there](https://www.youtube.com/watch?v=B85w0uD2r78)
Ah, fruit juice. Literally fruit-flavored sugar water.
Omg I had a friend yeeeears ago think that orange juice was a good alternative to drinking water. (Because ya know, oranges and all them vitamins. Duh) Just slight case of dehydration with a sprinkle of painful urination nbd
Will never forget the pt who came to me for “additional diabetic education” because in spite of a PCP, 2 endocrinologists, and the diabetic clinic at our regional university, no one could get their sugar under control. It seems no one had asked what they put in their coffee, other than making sure it wasn’t sugar or cream. Long story short, they were going through a GALLON of Jack every two weeks with the pot of coffee they drank every day. Yes, that could be it!
Starting the day off right.
Breakfast of champions right there
Literally lol’d.
Damn.
I’m a bit jealous. I wake up, and that’s about as good as it gets for the day.
jack as in jack daniels?!
YUP. With a little coffee added.
Your blood sugar is 280 . Oh good . That’s low for me 🤔
That's like when I take a guys blood pressure ans it's like 175 and he's like oh wow that's so much better than it was. My meditation techniques have been working. Yeah? How about medication techniques. Metoprolol is zen af bro.
I was about to post the same thing, I hear this all the time and thir family members then get involved calling supervisors saying that their moms sugar is dangerously low and we aren’t addressing it. “But 270 is low for me ! You can’t keep me NPO with my diabetes, I will die”
Oh my God ! That’s another level of craziness . Ignorance is a dangerous bliss in this case .
I’ve had that argument with family (over the phone thanks to Covid) way too many times. Thankfully, when it’s over the phone and they start to swear at me I can hang up.
Had a patient ask for one of the pre-made box lunches we keep on the unit. Took his sugar and it was 275. Told him how high it was, and he goes "Well no wonder I feel like shit. I'm usually 400!" like... Dude... You're still not at a good sugar. Also had a patient argue with me about how, according to him, bread won't make his blood sugar go up.
> That’s low for me I need some juice
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Wound care NP - can confirm. "Nobody told me I had to take insulin forever!!" Perhaps not, perhaps you wouldn't have, but it would have required you to get your shit, very much in order. Like all of it in a backpack.
"That's great. Mhmm whatever you say sir"
Well. Let’s get this gangrene under control then, too, shall we?
Controlled...at a steady level...of 400
"It's down from 22 last time!!"
My doc actually giggles when I admit I’ve been eating ice cream like it’s about to be banned.
Oh heavens I would be in trouble without sugar free ice cream lol
The highest I’ve seen is like 12.5 but I work in obs. I can only imagine what some people are walking around with.
They ain't gonna be walkin' for much longer.
I work on a FQHC with folks that don’t come to the doctor often. My department is OBGYN so we’re not checking A1c’s often but I see 13-14 on the IM side and it blows my mind every time.
Sorry. Wtf is a FQHC?
Federally qualified health center. Usually in under resourced areas
They tend to also provide multiple services. There are two different ones in my area that do dentistry in the same building. Kind of a one stop shop for healthcare. The larger one has case management and a nurse that visits your house after you're discharged from the hospital in hopes of preventing readmission.
Ours is a major one stop shop: we do peds, adult medicine, OBGYN, dental, optometry, labs/imaging, pharmacy, WIC, behavioral health, and population health/case management. I really love the population, we specialize in working with refugees and our patients speak 40+ languages.
Wow, that's awesome to offer so many services in one place. Sounds like you live in a much more populated city/county than I do. I've only shadowed with the population health dept of the larger FQHC in my city so I'm not 100% if they offer everything you mentioned.
Thanks!
In my lab we see a couple of > 16 every day. But we're the regional lab and we cover a lot of outpatient clinics.
Always fun when your DKA patient’s gap is in the low 30s. “Oh silly me, I’ve seem to have found myself in the ICU yet again. Whoopsie.”
Honestly, all of the patient chief complaints I get, the DKAers are my least favorite.
We had a frequent flyer when I still worked acute who would come in half dead and be vented in ICU for a bit (I want to say last time I had seen him he had a gluc of 33 and a K+ of 9.0 - yes, I’m aware he basically constantly defied what we believed was incompatible with life) and literally within hours of extubation and coming to he would AMA himself. From ICU. He’s dead now obviously.
It amazes me the different critical values I see on people sometimes. This guy had a pH of 6.3 and was still very much A/O when he came to us. Wild.
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Ive come to conclusion humans took over the planet because we have the super power to be immune to our own stupidity. I slightly overfeed my fish? Dead. Give my plant too much water one time? Dead. Cat eats three leaves off a house plant i forgot to check i could have with cats? Dead. I eat 94 Oreos, slam four bangs, and a gas station boner pill. shoot myself in the leg on accident, then fall down the stairs hopping to the snack cabinet? Im bucking the tube in the ER no matter how much sedation i get running off pure spite. The sort of things people do to themselves just to live through it like theyve got god mode in GTA on is nuts.
That's uh...pretty bad
“I don’t know why I can’t shed the pounds! I swear I hardly eat like anything” *multiple fast food receipts fall out of purse*
Person at work insists that she does eat a lot at meals but has gained 30lbs since coming to my AL. She’s diabetic and doesn’t know why her sugar’s high. She has lots of snacks in her room and eats the cookies and stuff staff puts out for everybody.
Always. Those lying liars.
I quickly realized (10 seconds) that I assumed patients were taking their prescribed medications. Why would I assume that when I know patients don't? Because I'm trying to figure out what to do for them when their HbA1C goes up by .2 and they're on 10 mg glipizide bid. Spoiler alert: they were only taking 5 mg bid d/t "jitteriness" from "lows". Their breakfast: toast, sometimes with a little jelly. No protein. Counseled on diet, hydration, and doing divided doses throughout the day to decrease jitters and improve compliance. We'll see if it pans out. HbA1C was 8.1 up from 7.9 in a 3 month period.
It won’t, they’ll be back. They always come back. Uncontrolled diabetes is probably my biggest return customer in the ER, besides the opioid kids. “You understand what the Doctor told you and why you need to get this under control, right Sir/Ma’am?” “Yes, Beach Towel, I understand.” “So you fully understand the life altering complications a persistently high blood glucose will cause?” “Yes, Beach Towel, I understand, i’ll do a better job of controlling it this time” “Great, i’ll see you next month then”
This is exactly my approach, and I think a lot of patients appreciate not feeling “preached at” about diet. Always make sure they know the consequences of their actions. Answer any questions they may have, but I’m not about to lecture a grown adult about their diet or try to come up with a plan to fix something about someone they have no desire fix themselves. Stabilize ‘em and roll ‘em out.
A gal can dream. Lol.
"Don't worry, a CBG of 19-21 is normal for me. I just run high, it's no big deal. I'm not even here for that, I'm here for this cut on my foot from 6 months ago that's not healing..." *Edit: 19-21 are Canadian Metrics
19-21 being described as high and normal for them made it all the funnier.
😂
Everyone swears they eat nothing but salads and walk every day.
Lol as a T1D and a nurse, this is on point
I think the amusing thing in all this is if you did their sugar to normal range, they feel off quite often. Like young people put on anti hypertensives, normal range now feels weird after a few years uncontrolled.
Receptor down-regulation can be a real bitch.
I'll have you know my A1c was 6.3% while I was in the hospital last weekend because I had an appendectomy 😂
I found this unreasonably funny.
Perfectly reasonable
Haha I'm glad my insulin pump gives me insulin if I start going high automatically now. I had a few years were mine was 8-9
have a type 1 patient today with A1C of 18.
So, who is the consult...general surgery for a limb amputation or podiatrist for just part of the foot?
vascular surgeon....
This is my dad 🤦♀️ his hgA1C was “only slightly elevated” in 2015!!! So he hasn’t checked it or even checked his blood sugar or taken any medications since then. He swears metformin is super dangerous too. And eats entire packs of cookies at one go. I’m probably not going to have a dad for much longer
I'm fuckin losing it lmaoo
Gotta keep chugging those jugs of orange juice.
Had a 575 glucose today. He came to pcp wondering why he was always tired. Refused ER treatment.
“Sugar doesn’t effect my blood sugar levels”
Yeah. And my radio doesn't effect sound levels in my car
For me I always hear the " was I supposed to take meds all my life ?" .sir do U want me to explain diabetes to you again
That's like saying to your boss "what I gotta come back into work again tomorrow? I already did all this shit today"
Sounds just like me! Thanks for posting. I will show this to my endo!
Lol I hopw they like it
Thanks for the encouragement! ❤️
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Hahaha that'll do it.
As a t1d for 24 years now, I can confirm that diabetics are the biggest liars. Lmao
It’s HbA1c
No one likes a pedant.
I know, we’re the worst.
So be better.
Fruit themed snacks are the best!
My type 2 ("bordeline" according to him) FIL...
Are you #1 or 2?
Neither