From Cape Girardeau, Missouri, USA:
I am a nurse working in a hospital. When my diabetic patients receive their meal trays there is almost always "no sugar added" orange juice on their tray, as well as other food full of carbohydrates, such as rolls, fruit, low calorie custard/puddings, slices of bread. I understand the dietitians might be counting the calories, but not looking at all the carbohydrates/sugars. I can usually never get my patients close to the normal range, 80 mg/dl [4.4 mmol/L] to 120 mg d/l [6.7 mmol/L]. Their sugars are always an average of 170 mg/dl [9.4 mmol/L] and higher. These people are usually on a sliding scale insulin, Regular or Humalog, that is given prior to meals or with the first bite and the patients are usually on oral medications as well. I have recently been removing the orange juice from the trays and have been getting great results. The patients, as well as their doctors, have been pleased. We were taught in nursing school not to give orange juice to diabetics, unless they are hypoglycemic, since it will raise sugars. Some other nurses said that this kind of orange juice is allowed on American Diabetes Association (ADA) diets. Is this true? That is what they heard from the dieticians, supposedly. I am not comfortable giving this to my patients.
As an example, the other day, a patient's blood sugar was 354 mg/dl [19.6 mmol/L] and it remained high like that for a couple of days. He was on sliding scale for Humalog, Lantus and oral glycemic medications. When he became a patient of mine, I took away the orange juice, which he didn't mind, since he didn't drink it at home any way because of what he was taught about his condition. That night his blood sugar was 174 mg/dl [9.6 mmol/L] before bed. That was the lowest it had been since he was admitted. He was very pleased with my action concerning his sugars. These patients think that they can eat anything that is put on there tray since they are in the hospital since we should know what we are doing and that is true. Could you please give me your opinion on this matter before I take this matter to a higher administrator at work? I can't watch what everybody eats in the hospital. It would help if the dietitians here could collaborate a little better with the meal plans.
It sounds like the dieticians need to refresh on their carbohydrate counting. I would agree that orange juice should not be with each meal. However, the diet does allow fruit choices and the hospital may find this easier to use.
I would discuss this with your specialists (endocrinologists) or other physicians on staff and ask them to assist in making changes. Coming from a "team" approach would be more effective with administration.
The other concern is the sliding scale system, which can lead to wide fluctuations in the glucoses. A possible solution is to have the insulin utilized tied to carbohydrate counting. I would not try to change the system alone but you are apparently improving the quality of care.
Last Updated: Tuesday April 06, 2010 15:09:56
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