Posts Tagged ‘Blood sugar’


Youth with T1 Diabetes Not Meeting A1c Targets: What Can Nurses Do?

February 13, 2013

By Jeniece Trast, MA, RN, CDE, clinical research nurse manager, certified diabetes educator, Children’s Hospital at Montefiore, Montefiore Medical Center, Bronx, NY

bloodglucosetestingDiabetes Care recently published an article showing that our youth with type 1 diabetes, especially those in adolescence, are not meeting glycosylated hemoglobin (HbA1c) clinical guidelines. The HbA1c is a blood test done every two to three months that shows how well controlled the glucose levels were over that time period. As much as this news is disappointing, I am not shocked by it. Type 1 diabetes is a challenging disease to live with at any age; however, the adolescent years definitely intensify the challenge.

As a nurse and certified diabetes educator (CDE), I take on many roles when caring for a teenager with type 1 diabetes: educator, team member, moderator, blood glucose assessor, advocate, cheerleader, and even role model (yes, I have type 1 diabetes also).

Challenges and responsibilities. When caring for these patients, keep in mind that type 1 diabetes is a difficult disease to live with on a day-to-day basis. People with type 1 have lots of important responsibilities just to stay alive: multiple insulin administrations each day; constant blood glucose checking; understanding the effects of exercise on glucose level both during and after exercise; balancing exercise, stress, food, and insulin; providing sick day care; assessing for and treating hypoglycemia; troubleshooting when things go wrong; carrying supplies at all times; and worrying about the disease’s future possible complications—just to name of few!

Particular stresses for teens. These obligations require education, clinical and psychological support, and motivation. Nurses can play a vital role in all of that. Additionally, teenagers want to feel “normal,” puberty occurs, growth spurts happen, peer pressures influence them, erratic lifestyles dictate their lives, they long for independence, and many other potentially difficult situations occur during adolescence. All of this contributes to the fact that these teens are not achieving optimal control.

What can nurses do? There are many things we can do with our teenage patients to help them achieve both their goals and our goals. Read the rest of this entry ?


What to Do If the Nursing Board Takes Action Against You: A Lawyer and Former RN Advises

June 1, 2012

At 7 AM, when RN Michelle Flacco took over the care of 66-year-old Lester Scanlon, who had dementia and type 1 diabetes, she was notified that his blood glucose level was significantly elevated, at greater than 550 mg/dL. Ms. Flacco performed blood glucose tests three times during her shift, each time after Mr. Scanlon had eaten a meal, and each time his blood glucose level was elevated. However, Ms. Flacco didn’t notify Mr. Scanlon’s physician, nor did she administer insulin to the patient. The next shift, Mr. Scanlon was found unresponsive, with a very elevated blood glucose level. He was diagnosed with diabetic coma. The incident was reported to Ms. Flacco’s state board of nursing, and she was accused of professional incompetence. The board is seeking revocation of her RN license.

That’s the opening of “You’re Being Investigated by Your State Nursing Board” in the June issue of AJN. The case described is a composite, but it illustrates a situation that a nurse can find herself or himself in. The article, currently open access, is by Margaret E. Mangin, who practiced nursing for 12 years before becoming an attorney. For the past 26 years, she has practiced law in San Diego, primarily defending hospitals, nurses, and other health care providers. This is the latest installment of our Legal Clinic column. You might want to check it out. The table below gives the most frequent licensing violations, 1996 to 2006.

Table 1. Most Frequent Licensing Violations, 1996 to 2006 (click image for larger version)

(Please do note: We hope you’ll find the article helpful, and we welcome comments, which we now moderate. But this isn’t the best place for advocacy or extensive outward linking related to recent controversial cases that have been exhaustively treated elsewhere as well as in previous posts on this blog; we reserve in advance the right to not approve them for posting, or to remove similar repetitive linking from our Facebook page, if need be. Thank you in advance!)—Jacob Molyneux, senior editor

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