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Insulin Decisions Based on Instinct, Not Science
Insulin Decisions Based on Instinct, Not Science -- Posted by Gumbo on 10-24-04 12:38
Insulin Decisions Based on Instinct, Not Science
Originally Published:20041006.
HEALTHCARE PROFESSIONALS use instinct over science when deciding when to put
patients with diabetes on to insulin, diabetes specialist nurses heard at
their annual conference last week.
The way caregivers make decisions about their patients has not changed since
the 1980s despite a surge in the amount of relevant information available to
them, the RCN diabetes nursing forum annual conference in York was told.
Paul Jennings, consultant physician at York Hospital, compared the
collective reluctance of professionals to initiate an insulin regime with
having to 'have our arms twisted before we act'.
He said: There has been a study, The Diabetes Attitudes, Wishes and Needs
Study, that examined the views of 5,000 people with diabetes and 4,000
healthcare professionals.
'It found that 59 per cent of GPs, 42 per cent of diabetologists and 51 per
cent of diabetes nurses would delay giving insulin until absolutely
necessary.
'Sixty per cent of people who look after patients with diabetes are worried
about starting them on insulin because of the effects it can have on
lifestyle.
'It is as though we have to have our arms twisted; we are working to need
rather than target. Almost all patients have HbAIC levels of more than 9 per
cent when they start on insulin, and that has not changed since the late
1980s. So we have all the information but we are not using it.'
Consultant nurse Maureen Wallymahmed of University Hospital, Aintree
Hospitals NHS Trust, Liverpool, reinforced Dr Jennings' comments in relation
to deciding insulin dosages. 'In Liverpool we do not do this scientifically
at all,' she said. 'I think most of us just pick a number out of the sky
because we think it will work.'
Consultant diabetologists Malcolm Nattrass of Selly Oak Hospital,
Birmingham, had a stern warning for professionals who, he said, risk facing
legal proceedings if they fail to put a patient on insulin. He told of a
girl diagnosed with diabetes at age 14 but not put on insulin until age 28,
by which time she had lost her sight and all feeling in her hands and feet.
'It cost the NHS trust £600,000 in compensation. You can employ a lot of
diabetes nurses for that. Do not ever try to use "they were not at all keen
on insulin" as a defence in court. The barristers will destroy you. Your
only defence is if they refused it, otherwise it will be viewed as though
you never offered.
'What are you being paid for? It is not just to measure blood glucose and
tell people to come back in six months' time. You are paid to make decisions
and that is the only reason for employing you.'
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