13.2mmol? Oh that's pretty good.

[Rosiecarmel]

We have a T2 diabetic patient on my ward. Got admitted yesterday. As part of their baseline observations, I did their BGs which were 13.2. On reporting this to my mentor, he replies with "well that's pretty good. Nothing to worry about"

I obviously questioned him on this as it shocked me and he quite bluntly told me that they've had worse on the ward. He said the diabetic nurse comes on the ward every month to see any diabetic or pre diabetic patients but mainly they're just left to the care of the ward staff. As we can't force patients to take physical medication (psychiatric medication is a different story) we just have to accept if if they refuse their tablets or even insulin.

Very sad indeed

It's the same with all physical drugs. Patients on drugs for high BP are at risk of stroke if they don't take their tablets but all we can do is monitor them and call an ambulance if necessary!

we can sit and explain the ramifications of not taking their meds but as most of them have quite progressed dementia, they don't understand or won't remember. Even my mentor admitted it's sad but their hands are tied really.

Dementia is such an awful disease

 

[Ljc]

Yes it is a dreadful disease , my mum had mixed Dementia. Soon I will PM you a forum I found very helpful, it's run by tha Alzheimer's society, I still go there so it would be a good idea to use a different name than a ou do here.

As a professional there is not much you can do other than try to persuade the person to take there medication.

 

[Diabeticliberty]

One of those conditions that I personally feels robs you of one of the few things you have left in old age which is your dignity. I watched my wife's grandfather go from a big healthy and permanently happy engineer who worked all his life become a complete stranger to his own wife and family. A truly dreadful condition

 

[Northerner]

Unfortunately I've heard of this attitude before. I think a lot of HCPs can base things on expectations because they don't really understand the numbers and what they mean - they might be used to seeing numbers regularly in the upper teens or 20s, so low teens are regarded as 'good'

 

[Ljc]

Unfortunately I've heard of this attitude before. I think a lot of HCPs can base things on expectations because they don't really understand the numbers and what they mean - they might be used to seeing numbers regularly in the upper teens or 20s, so low teens are regarded as 'good'

I agree with you,
With the knowledge of mums doctors I used to give my mum her meds covertly as she thought they were poison. I'm not sure of this but I don't think they are normally allowed to do this in hospital unless they have been sectioned and then they would be in a psychiatric hospital.

 

[Amigo]

This is why Advanced Directives are so important so that people can expressly set out what level of medical intervention they want once they are deemed to no longer have mental capacity. I don't have a Lasting Power of Attorney for my mum but am still carefully consulted about decisions concerning her. This has included the Do Not Resucitate Directive (DNR). Nominated 'attorneys' (who are usually family members) can make decisions about administering medication (covertly if necessary) with the person's medics but if advance directives prevent it, then they cannot intervene.
Best Interest Assessors can be consulted to carry out a DOLS (deprivation of liberty) assessment in situations where the person is deemed to have lost capacity and is putting themselves at risk as a result of their actions.

In terms of diabetic levels, to be honest I think sometimes there's a prevailing attitude that it's the least of their troubles once advanced dementia strikes. I've seen the standards set for the physical health of dementia patients being much lower regrettably.

I worked in this area of work for many decades and managed Best Interest Assessors under the Mental Capacity Act but once it hits you personally, nothing prepares you for the emotional turmoil it causes (as I've personally experienced over the last few months)

 

[trophywench]

That's why I was terrified when my memory was on it's way out - and my mother had senile dementia - she became a stranger masquerading in my mom's body and clothes, then of course 'her' body disappeared and actually she stopped looking permanently perplexed, so that was kind of 'good' - except there we were expected to visit this blob that didn't know anyone let alone us, couldn't communicate, ate like a pig ...... if I do get it, please smother me.

Neither of us cried when she eventually died. It was weird - but I'd done my crying years previously - I may not have actually liked her much - but I did love her.

Fortunately mine was cured dead easily - by stopping taking the ruddy statins!

 

[Vicsetter]

1. I wouldn't regard 13.2 as a worrying reading (it does depend on when it was taken of course), it certainly wouldn't worry me if it were mine.
2. there is an attitiude that says if you are old and you are running high blood glucose, does it really matter that much as the risk of complications within their lifetime is limited. My mother was handed metformin and told to take them and that was it as far as her GP was concerned.
3. pestering and or forcing people to take their medication with dementia is going to be distressing to the patient at best and some people cannot be bothered to look after their own condition even when they don't suffer from dementia.

 

[Amigo]

1. I wouldn't regard 13.2 as a worrying reading (it does depend on when it was taken of course), it certainly wouldn't worry me if it were mine.
2. there is an attitiude that says if you are old and you are running high blood glucose, does it really matter that much as the risk of complications within their lifetime is limited. My mother was handed metformin and told to take them and that was it as far as her GP was concerned.
3. pestering and or forcing people to take their medication with dementia is going to be distressing to the patient at best and some people cannot be bothered to look after their own condition even when they don't suffer from dementia.

A big part of me agrees with you Vic because quality not quantity of life becomes important once people have more advanced dementia. However, the only concern I have is how inadequate physical treatment and adherence to helpful medication can increase and aggravate the dementia. I've had to advocate for my mum over the past few weeks when she was given meds which had the effect of causing her physical symptoms and further depressed her cognitive function. The medical view towards people with all forms of dementia (and there's a 100 types), is a sense of fatality and I've had to battle that because it was causing my mum additional physical and mental distress. Since she's been taken off the offending meds, she's been much better and despite having dementia, is still of great value to me and her family. But I've no doubt that if her BG's were 13.2, nobody would bother too much (until I got on to them!).

 

[Amberzak]

Question. If a teenager is refusing to take insulin and will die, are you still not allowed to force them? What if it's someone aged over 18 but is a vulnerable adult like autistic or something.

 

[Amigo]

Question. If a teenager is refusing to take insulin and will die, are you still not allowed to force them? What if it's someone aged over 18 but is a vulnerable adult like autistic or something.

The medics (or family) could presumably apply to the Court of Protection for a ruling.
The key issue is whether the person is deemed to have mental capacity to make the decision. Courts have a tendency to support the rights of people to make their own decisions, including refusal of life saving treatment, as long as it can be established that mental capacity exists.

 

[Rosiecarmel]

Question. If a teenager is refusing to take insulin and will die, are you still not allowed to force them? What if it's someone aged over 18 but is a vulnerable adult like autistic or something.

That depends entirely on the situation. If they are a psychiatric inpatient (that's the only situation I'm aware of, sorry) and they're refusing their insulin and they lack capacity it's entirely possible to get hold of an independent mental capacity advocate (or family actually but an advocate usually gets involved and works with families) who can make a "best interests" decision for the person. This is in line with the Mental Capacity Act that states that as professionals we must do everything possible to save a life or prevent permanent harm.

It does get complicated as if the person is still refusing and they have a best interest policy in place, they can end up being restrained and injected against their will. This can cause significant distress to patients which is the opposite of what we want to do!

If a person is deemed to have capacity and refusing their insulin there's nothing we can do. We would just monitor their blood sugar and ketone levels and call an ambulance when needed.

This applies only to patients detained under the Mental Health Act (different to the mental capacity act) If a patient is informal, again, there is nothing we can do apart from monitor their health if they allow us to.

 

[Amberzak]

Yeah. See, I was just wondering because there's a girl I know from college who is a type one and also petrified of needles. She was telling me the other day that she can't wait until she's 18 because then her mum can't force her to take her insulin, and she doesn't inject at college.

 

[Sally71]

Yeah. See, I was just wondering because there's a girl I know from college who is a type one and also petrified of needles. She was telling me the other day that she can't wait until she's 18 because then her mum can't force her to take her insulin, and she doesn't inject at college.

😱😱😱 Does she understand that she will die if she doesn't inject it?! I realise phobias are pretty strong but they can be overcome, is the survival instinct really weaker than the fear of doing what's necessary to stay alive?!

 

[Amberzak]

😱😱😱 Does she understand that she will die if she doesn't inject it?! I realise phobias are pretty strong but they can be overcome, is the survival instinct really weaker than the fear of doing what's necessary to stay alive?!

I know. I said the same thing to her. And I told her that I was afraid of needles when I was first diagnosed. She autistic like me. I told her she needs to be honest with her diabetic nurse and tell her what the problem is, because they can find ways to help. For example, it used to be that when I injected, I would put some gel on my belly that numbed it a bit.