I’m sitting infront of the tv on a friday night.  I’m at home, on my own and on facebook.  Nobody’s around and I could easily binge and purge, or I could even purge my dinner which I had a few minutes ago.  There’s a lasagne, pasta, sauce, chocolate rolls, everything you could want.

Since a couple of days ago when my nutritionist declared that I was to be hospitalized in the next 2 weeks,  I’ve been binging, purging and restricting non-stop.  It’s as though I’m trying to already make up for the time I’ll lose whilst there: a whole 2 months. 

I still don’t know what’s going to happen tonight. 

I don’t want to be the ‘fat bulimic’ when I get to the ‘hospital’.  However I don’t even know if it’s a hospital specifically for patients with eating disorders, or whether it’s for teenagers with various mental disorders.  I never thought I’d say this but…. thank God for the NHS.

I realise this is the most boring and monotonous post ever, in the history of boing, generic eating-disorder-related posts. 

Insulin Critical Thinking Discussion

I wanted to clarify the insulin discussion from yesterday. When I talk about withholding insulin, I am referring to withholing it at home and as a standing order when the patient is already hospitalzed the morning of surgery. At home or in the hospital setting you have “sliding scale” insulin orders or in the case of oral hypoglycemics standing oral orders—which we have not yet discussed. Those are what are withheld prior to going to the OR. They are withheld for several reasons. First, the patient is NPO and secondly time of surgery is not an exact science. Delays happen all the time which can be devestating if the patient has received their routine sliding scale insulin doseage. 

Blood sugars are monitored in the pre-peri and post op phases and may be given during those times. 

The reason I am so adimate about this issue is that I have seen TERRIBLE consequences for a patient when a nurse just automatically gives sliding scale insulin to a patient that’s going to surgery because it was “ordered”. There are times when a physician will write pre-op sliding scale orders for a patient. While those are ususally fine to give, they still require critical thinking before you just automatically give it. If the surgery is delayed those consequences can still be dire.

Patients with Type 1 diabetes are fragile—their sugars can go from 150 to 40 in minutes. I never want you to walk in and see your patient seizing because you gave their insulin to them and then they weren’t able to eat.

As care givers we give a lot of dangerous drugs, but because insulin is so commonplace in our society, we tend to blow it off. In 28 years of being a nurse, I have seen more dire patient consequences from insulin than any other medication. It deserves our respect and I want you all to stop and critically think about your patient and how they will react to that drug before you give it. This is especially true in the pre-operative phase since there are so many variables that are out of our control.