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Low Glucose Leads to High Anxiety

Jan Chait

May 26, 2009

The time was nearing for my surgery and I was getting more and more agitated. Not about the surgery, mind you. No, it was about my blood glucose levels. Despite lowering my basal rate, my glucose wouldn’t go any higher than 70-something mg/dl. Because I was having general anesthesia, I couldn’t eat or drink anything to raise it.

“Is it OK if I have a tube of glucose gel?” I asked the nurse. Her response was to call the anesthesiologist.

“Put your pump on suspend,” she related as she began to draw up a huge syringe full of dextrose to add to my IV bag. “He’ll handle your sugar.”

Now I was really getting agitated. What did he know about diabetes? Did he know what my ratios were? My correction factor? No, he hadn’t even asked. Besides which, I did not want dextrose. I know what those people do: They whack your glucose up to stratospheric levels just so you won’t inconvenience anybody by committing hypoglycemia.

Oh, well. Nothing to do but submit to the evil medical mavens who outnumbered me, a humble civilian who only takes care of her diabetes 24/7/365.

And so it went until the anesthesiologist shut me up in that special way that only an anesthesiologist can.

Much to my very pleasant surprise, my glucose was 109 mg/dl when I checked it after surgery. The man actually knew what he was doing!

Come to think of it, the anesthesiologist for my surgery in April at the same hospital left me alone, too: I was at 130-something mg/dl before I went to surgery and 130-something mg/dl when I checked after surgery.

That’s in contrast to a surgery I had several years ago in that hospital when the anesthesiologist shot in those magic drugs that shut you up in a hurry as I was trying to tell him my insulin pump would not automatically give me insulin for a breakfast I had not eaten. That time, I was in the 300s after surgery.

Are things beginning to turn around? Here and there once in a while? I’ve had — and have — some pretty understanding people in my life, but most are in the diabetes field. Back in the ’90s, there was Sonja, an RN and CDE, who taught me about diabetes. And Amy the RD, CDE, who worked with me to figure out what foods I liked and when I normally ate to figure out a meal plan I could live with.

Then there’s Dr. Ski, my long-time endocrinologist who actually understands that people with diabetes really are people first, with a life outside of diabetes. (And if he slips, I tend to remind him that I have another life.) I still chuckle when I recall the time he was going over the numbers in my log and said: “What happened to your numbers he… Oh. The holidays.”

I went to a program on diabetes at which my family practice doctor gave a talk. He did an excellent job. (He doesn’t deal with my diabetes, since I see an endocrinologist.) When I was looking for a new doctor and interviewed him, he was not all that knowledgeable about diabetes. I chose him because of his willingness to learn. And learn he did!

More do need to learn. Although medical professionals are required to take continuing medical education (CME) courses, the subject areas are not specified: They can take anything they want as long as they get in the hours. Several years ago, I attended a CME course on diabetes here and was shocked at the number of doctors who did not attend. (Although I will say that the female docs who went to the ladies room at the right time did get to attend an in-service on changing an insulin pump infusion set.)

It’s been estimated that one out of every five patients seen by a primary care doctor on a typical day has diabetes. If your doctor appears not to know about today’s diabetes care, it’s up to you to educate him. Perhaps he hasn’t had the time to read up on diabetes. Perhaps he believes that what he learned in medical school in 1965 is sufficient to treat diabetes today.

Are things changing? I hope so. Even if it’s just a little bit here and a little bit there. Positive changes in the medical field can lead to positive changes in the people they are treating for diabetes.



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