Monday, April 28, 2008


I returned from Sacramento today and that is why this blog is being posted late. I have spent the last several days with my mother who has metestatic breast cancer. Although she "looks" better than I expected, the last several days have been filled with nostalgia, emotion, regret over misunderstandings and lost time.


My older sister has been diagnosed with diabetes within the last year. Her physical condition had deteriorated to such a shocking degree that at one point, her hair had fallen out and she'd lost a severe amount of weight before she was diagnosed. Her physician started her on medication for diabetes, instructed her to take her blood sugars and how to regulate her diet.

After learning all of this over dinner one night, I was very shocked. She spoke very matter of fact about the entire thing. She asked me a few questions. Told me she was having trouble with her vision and that she had pains in her feet and legs. As a nurse, that sent up the red flag in my brain. She is newly diagnosed, but has vision trouble and diabetic neuropathy already? Her chances of going blind from this disease is a very distinct possibility. And are her leg pains from the narrowing and hardening of the vasculature in her lower extremities, or strictly nerve pain? Difficult for me to tell from just looking at her, but again very distinct possibilities.

I asked her what meds she was taking and her response to me was, "Oh, I quit taking my medication. I gained my weight back and I feel better. I'm cured."

She'd fallen into a trap I've seen before. Because she felt better (as a result of the treatment and management of her diabetes) she'd been lulled into a false sense of security. Obviously, I couldn't reach across the dinner table and grab her by the shoulders to shake sense into her. I wanted to shout "WHAT???? ARE YOU INSANE????"

Without freaking out right then and there, I very calmly said to her, "There is no cure for diabetes. You can regulate your diabetes with diet, exercise and medication but once you have it, you have it. You are gambling with your life."

And here is why she is. When you abrubptly stop taking insulin or oral diabetic medication, sugar stays in your bloodstream instead of going into the cells of your body where it is used to nourish your cells. She is putting herself at risk for going into DKA~Diabetic Ketoacidosis or, HHNC~Hyperosmolar hyperglycemic nonketotic coma (which will overlap with DKA) but characterized with blood sugars usually over 1000 (I think. I'd have to look that one up again)

Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency aggravated by hyperglycemia (high blood sugars), dehydration, and acidosis. The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes (because people who are newly diagnosed aren't on medication and their blood sugars are wildly out of control). DKA is typically characterized by hyperglycemia over 300 mg/dL (I've had patients admitted with blood sugars in the 900 to 1100 range before), low bicarbonate level (<15 mEq/L), and acidosis (pH <7.30).

Classic symptoms of hyperglycemia (A fancy term for high blood sugars)

Polyuria (frequent urination), polydipsia (drinking large amounts of fluids and still feeling really really thirsty)
Nocturia (frequent urination at night)

Other symptoms include:

Generalized weakness
Decreased perspiration
Anorexia or increased appetite

Symptoms of associated infections and conditions:

Chest pain
Abdominal pain
Shortness of breath

Physical General signs:

Ill appearance
Dry skin
Labored respirations
Dry mucous membranes
Decreased skin turgor
Decreased reflexes

Vital signs:

Tachycardia (A very fast heart rate)
Hypotension (A very low blood Pressure)
Tachypnea (fast respirations)
Fever, if infection is present

Specific signs:

Ketotic breath (fruity, with acetone smell)
Abdominal tenderness

Treatment of DKA:
You'll be placed in an ICU and we will administer IV fluids at an extremely fast rate for fluid rescusitation. We'll check frequent labs and start you on an insulin drip. Potassium replacement will be important, too.

This is a very dangerous situation and people can die from DKA.

So please!! Don't be lulled into a false sense of security because you start to feel better. You are feeling better because of the medication and treatment your doctor has prescribed for you, not because you are "cured". You are gambling with your life!

And as always, I'll end my post with a reminder to shoot on over to and check out her upcoming auction for diabetes research which starts on May first!!

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