Day of Diabetes

Yesterday I got to recommend a tube feeding for a ventilated patient in the ICU. It was fun. Later that day, on a follow up, I got to change another tube feed. I had noticed from the previous nutritional assessment that the protein needs recommended seems really high for an 85 year old woman who was bed bound, they were 120 g I think. So I mentioned it to my RD and she agreed. It said in the chart that the patient had a foot wound, however, upon talking to a nurse and a doctor it turns out that it was barely even a stage I ulcer and had mostly healed. So her protein needs were not nearly so high. This taught me the importance of talking to the nurses, it helps give you the whole picture on a patient. So the dietitian aided me in tactfully putting in my note the changes we made to her TF and why, in case the other dietitian noticed that her recommendations were changed.

Today I followed around the CDE, which was really great and informative. She is a former oncology nurse who realized she loved teaching patients and is now a CDE. She is also able to change diet orders even though the RDs here can't do that, which is a little frustrating. She focuses mostly on medications and insulin however, and she consults to us about dietary issues. It is all very complex. We spent most of the day in rehab. Two of the patients had had strokes and only had use of one arm. So, it is REALLY difficult for them to actually give themselves insulin shots or use the insulin pen. The CDE ended up doing some occupational therapy type things, teaching them techniques about using the devices with only one hand. Patients noted that they have realized the importance of using their mouth to help them open things now. Most of the patients seemed really receptive to the education and many were very gung ho about controlling their diabetes. Except the type I diabetic lady who was about 50 I think. The CDE said that type I diabetics are often harder to work with than type II and that the best approach she has found is just to ask them if there is anything she can help them with, instead of going through the whole spiel about diabetes. Adolescent type I's are the hardest she says, which makes sense. The renal diabetic patient we saw was really confused about what he actually could eat, having both ESRD and diabetes, but he was controlling it so well with just diet, it was inspiring and he was like 85!