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Type 2's and carb counting.

Discussion in 'Adults with Type 2' started by MrsBadshoe, Mar 7, 2013.

  1. MrsBadshoe

    MrsBadshoe Super Moderator

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    I started my first hospital nursing job and was given a sliding scale for insulin dosing I'm really hoping for just type 2's but it doesn't state that.....

    My question is why don't type 2s just carb count and use Insulin sensitivity factors to correct and bring down high Blood sugars... I'm still starting to learn about type 2 and this was the first thing that I noticed was so different. Instead they just dose insulin based on BS on a sliding scale.
     
  2. TheFormerLantusFiend

    TheFormerLantusFiend Approved members

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    When you're in the hospital, lots of people are there who are not diabetic but who have high blood sugar just because they are really sick. It makes more sense to react to the high blood sugars than to anticipate that they would become high, especially because low blood sugar is not a good idea.

    Outside the acute setting, of course carb counting makes better sense.
     
  3. ChristineJ

    ChristineJ Approved members

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    In my almost 20 years of nursing, I have observed that diabetes management and treatment protocols for Type 2, unfortunately, continue to be much less advanced than management of T1. Use of sliding scales instead of carb counting/I:C ratios is one example of that, in the acute care setting as well as out in the community. :(

    Christine
     
  4. jbmom1b2g

    jbmom1b2g Approved members

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    I know when I was in the hospital after my surgery they had to give me insulin due to my BG being high. They didn't carb count they just dosed me on what my blood was. They even feed me pasta.
     
  5. nanhsot

    nanhsot Approved members

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    Working in hospitals is challenging, now that I know more about diabetic management. IME it's rare for hospitals to do a good job with it, sliding scales are the norm, giving insulin well after meals is typical, people on insulin for the first time of their life and then abruptly taken off at DC, meals are full of "diabetic" options (which are not carb free by any means), etc.

    I actually got into an argument with the RN in charge of a patient who told me (when I asked for a meal prebolus as he was fighting highs all day) "insulin doesn't work that way". I finally walked away in defeat and the poor patient was left with his food getting cold because he knew better and wanted his insulin before he ate.

    IME hospitals treat T1 and T2 on a sliding scale, unless the T1 advocates for him/her self. On the sliding scale sheet at the hospital I work at on occasion it states to give glucose tablets for BS below 70. There are NO glucose tablets to be found. I once had a nurse give a glass of milk to a patient who was 45. I went and got some juice and mixed in a packet of sugar and she wouldn't use it, said milk was better. He fought lows all that day.

    IME working in the home setting most Type 2s don't regularly test their blood sugar. Rare is a patient who tests fasting every day, and very rare is one who tests before every meal, even those on insulin. They tend to just inject the amount they are prescribed and eat a mostly typical sliding scale meal. I've never met a T2 who has heard of glucagon, including those on insulin.

    I personally believe education is horribly lacking for Type 2s and for hospital staff. I feel good about our home health agency as we have a CDE on staff and work on this but it's frightening to me what I see out there on a regular basis.
     
  6. Michelle'sMom

    Michelle'sMom Approved members

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    Many T2s still produce insulin, even those who inject. If they dosed for carbs as well it could easily cause a hypo. One of the underlying issues is the amount of glycogen released by the liver. That's why T2s generally start out with only injected basal insulin.

    I absolutely agree the education for T2s is lacking.
     
  7. deafmack

    deafmack Approved members

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    I know a lot of people with type 2 that count carbs and dose accordingly but that is because they have learned to do so by themselves or from others who do so. Hospitals tend to do sliding scale because it is easier for them to do and takes less time. I think it is important for the person with diabetes to advocate for themselves so they are able to dose using the carb counting method.
     

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