Tumgik
#nurblr
macgyvermedical · 2 days
Note
Do you know how our understanding and treatment of diabetes has changed through history?
Oooh good question, anon!
As you may guess, diabetes mellitus is not new.
Tumblr media
We've known about it since at least the Ebers Papyrus (1550 BCE) when the disease and a treatment was first described. This treatment was: "a liquid extract of bones, grain, grit, wheat, green lead and earth." I did not look these up, but I would guess they did not do a whole lot for the treatment of diabetes.
Later during the 6th century BCE it was first given a name when it was described by Hindu physician Sushruta as madhumeh or "honey urine."
Honey urine is a very apt descriptor for diabetes. In any type, one of the most measurable symptoms is that the person urinates a lot, and the urine tastes sweet (or, if one didn't feel like tasting, that it ferments, or that it attracts ants). This was also the first test for diabetes.
The reason for the sweetness of the urine (as well as a lot of other general info about diabetes) is spelled out more clearly in my "Don't Be That Guy Who Wrote Hansel and Gretel: Witch Hunters" post.
A Greek physician Apolonius of Memphis named it Diabetes, meaning "to siphon" (referring to the large amount of urine lost).
Roman physician Aretaeus later made the first precise description of diabetes. This included the classic symptoms of incessant thirst, copious urination, and constant hunger leading to emaciation and death. He also notes that if deprived of water, the patient will continue to urinate until they become so dehydrated that they die.
The term "Mellitus" was not added until the 1600s by an English physician Thomas Willis. This was again due to the sweetness of the expressed urine. Willis prescribed a diet of "slimy vegetables, rice, and white starch. He also suggested a milk drink which was distilled with cypress tops and egg whites, two powders (a mixture of gum arabic and gum dragant), rhubarb and cinnamon". Supposedly his patients improved if they kept to this diet, though few managed it long term. I honestly don't know how it would have worked, even temporarily.
A major breakthrough came in 1889 when it was discovered that if you removed the pancreas from a dog, the dog would become diabetic (particularly, that it would urinate large quantities of sweet urine). Up until this point it was thought that diabetes stemmed from the kidneys and bladder, or perhaps the lungs. This was the first time it had been shown experimentally that the pancreas was the problem.
Speaking of this, this was also part of a series of experiments where an English physician named Merkowski implanted a small amount of pancreas in the pancreas-less dog's fat, which reversed the diabetes temporarily. This proved that the pancreas was making something that helped regulate blood (and thus urine) sugar.
What this was wasn't figured out until 1921, when Canadian scientists Banting and Best (with help from McLeod and Collip) isolated something they called insletin (after the islets of langerhans, where the substance was being produced). It's important to note that all of these scientists hated each other so much they almost refused a Nobel Prize over it. Later, Collip would refine the substance and McLeod would rename it insulin.
Prior to insulin existing there was basically 1 vaguely useful treatment for diabetes. Unfortunately, that was starvation. So you could either die a slow and painful death by diabetes or you could die a slightly less slow but still painful death due to eating about 500 calories per day. Either way, diabetes was fatal, usually within a couple of years of diagnosis.
By 1923, the first commercial insulin product, Iletin, had been developed. Iletin was a U10 insulin (10 units per 1 milliliter- less potent than today's U100 and U500 insulins) and was made from pork pancreases. It took nearly a ton of pork pancreas to make 1oz of insulin. Fortunately, as a byproduct of the meat industry, pancreases were readily available.
Tumblr media
Now, you might be thinking- no one has mentioned type 1 or type 2 yet in this entire post!
Well, you would be right, because diabetes wouldn't be split into 2 forms (insulin-dependent and non-insulin dependent) until 1979, and wouldn't be classified as types 1 and 2 until 1995. That's right- some of you were alive when there was only one kind of diabetes out there.
Now, there's more about the types in the Hansel and Gretel post, but essentially type 1 diabetes occurs when the pancreas itself stops producing insulin, usually in childhood. When this happens, the body stops being able to use sugar (insulin, a hormone, acts as a "key" to let sugar into cells for use). Without replacing that insulin, the person dies because their cells starve.
Type 2 diabetes occurs when the pancreas still produces insulin, but the cells stop responding to it correctly. This causes high sugar levels in the blood, which causes longer-term complications (infections, ulcers, blindness, neuropathy, heart and kidney disease, hyperosmolar syndrome, etc..) which eventually lead to death.
We started discovering oral drugs that worked on what would later become type 2 in the 1950s. Particularly those that worked by increasing the insulin output of the pancreas, but only when the pancreas was still producing some insulin.
Predicting which diabetics would benefit from oral therapies was challenging, but it was recognized that when the onset of diabetes was slow and came on in adulthood, the oral agents would work, while if it came on suddenly in childhood, the oral agents wouldn't. Terms like "adult onset" and "maturity onset" were common:
Tumblr media
(Side note: if you have ever read Alas, Babylon (1955) there is a diabetic character who by today's standards clearly has type 1 diabetes, but wants to switch to the "new oral pill" (called "orinase" in the book, though they are likely referring to diabinese pictured above).)
From 1923 into the 1980s, insulin was given once or twice per day, and not particularly titrated to blood sugar. This was probably just because we didn't have a great way to measure blood sugar in real time. Pre-1970s, there was no way to test blood sugar outside of a lab setting.
Tumblr media
Urine testing was common starting in the 1940s, but was cumbersome as it required a flame for heating the urine. By the 1950s, a test had been developed that didn't require a flame, but was still not practical for home use. In the 1960s, paper strips were developed that changed color for different amounts of sugar in the urine. The problem with this was that the strips couldn't change color until there was sugar in the urine- a blood sugar level of over 200 by today's measurements. Low blood sugar readings were impossible at this time, and had to be treated based on symptoms.
In the 1970s, blood sugar could finally be measured by putting a drop of blood on a test strip, wiping it off, and matching the color of the test strip to a chart. While less cumbersome than urine tests, this was still something that would generally only be done at a doctor's office.
Tumblr media
In 1983, the first home blood glucometer is developed. Finally, it was practical to take one's sugar multiple times per day, and it becomes possible to experiment with "sliding scale" insulin injections that keep tighter control of blood sugar. By the late 90s, continuous glucose monitors became available- though unlike today's CGMs that allow readings in real time on a smartphone or monitor, these had to be downloaded to a computer at regular intervals.
The 1980s were the first decade where insulin pumps become widely available. The very first pump was large and had to be carried in a backpack, but it represented a huge step forward in glucose control, as it more closely mimicked the function of a working pancreas than once-daily injections.
For the next 30 or so years you really had to work to qualify for an insulin pump, but recently it's been found that pumps greatly improve compliance with blood glucose control whether or not the person had good compliance before getting the pumps, and insurance has gotten better about covering them (though CGMs are still a pain to get insurance to cover).
The 1980s was also the decade that recombinant human insulin (insulin made by genetically modified bacteria) was first used. Up until that point the only insulins were pork and beef insulins, which some people had allergic reactions to. Recombinant insulin was closer to regular human insulin than beef or pork, and represented a big change in how insulin was made.
Today for people who take insulin to manage their diabetes, insulin is usually given as a single injection of a long-acting basal insulin, coupled with smaller doses of ultra-short-acting insulins with meals or snacks. This is the closest we've gotten to mimicking the way a pancreas would work in the wild, and keeps very tight control of blood sugar. This can be done by fingerstick blood sugar tests and individual injections of insulin, or it can be done with a CGM and pump- it just depends on the resources available to the person and their personal preference.
81 notes · View notes
iheartvmt · 11 months
Text
Gotta love vet techs lol
Tumblr media Tumblr media Tumblr media
3K notes · View notes
populationpensive · 11 months
Text
Abdominal Pain PSA
I've had a run of people admitted to the ICU after have 1-2 weeks of abdominal pain who were struggling to eat or drink that ended up having conditions leading to necrotic bowel. Dead bowel makes people incredibly sick. Like, death's door sick. Anecdotally, I'd say maybe 60% of our patients make it through such an ordeal. Every time I talk with their families, their loved ones say that they looked bad and they tried to get the patient to go get some help. Often, these people wait too long.
So.
PSA: if you're having abdominal pain and can't keep anything down for more than 48 hours (especially in the context of N/V WITHOUT bowel movements), you NEED to go to the ER. Not urgent care. Not your PCP. The ER. Please get checked out. Do not let things sit. If you have known GI disease like diverticulosis, a hernia, etc, even more of a reason to get checked out.
160 notes · View notes
quisters · 2 months
Text
normalize gay nurses.
47 notes · View notes
Text
Tumblr media
47 notes · View notes
lamentations44 · 11 months
Text
Hey hey hey- its MELANOMA AWARENESS MONTH!
Put your sunscreen, hat, longsleeve, full coverage bathing suit, etc on!
April 2016 I had a malignant melanoma removed from my back- I still have a significant scar as a reminder. My husband had a melanoma removed a few years after that and we have been vigilant since.
Unfortunately- I had a mole come back after my last visit as a “severely atypical nevi” and had to have a surgical excision( today). These moles or nevi are not ALWAYS cancer or dangerous- but from what I gather, convert easily to melanoma. Given my sordid history with melanoma- the choice was a 2.5cm surgical incision/ removal. I was grateful it was less than the 11cm from the previous melanoma. However- this one is slap dab in the middle of my abdomen. So now, thanks (likely) to my idiotic youth and bikini choices- I will sport- not a cute bikini- but a large surgical incision on my back from 2016 and a medium sized one on my abdomen from today.
Please- be careful. No matter what beautiful skin tone you are- be careful and get SCREENED.
We can PREVENT two cancers- SKIN and COLON. Be smart and screen regularly for both.
Tumblr media Tumblr media
(Abdomen from 5/5/23). Back from (4/2016)
117 notes · View notes
Text
Tumblr media Tumblr media
8/5/23 // 22.28
Going on pretty walks: 1
Understanding neurology: 0
83 notes · View notes
Text
Sometimes it's not a good thing to be a hospice nurse.
I found a lump on the front of my throat a while back, and mentioned it to my nurse practitioner when I went for my yearly physical. She couldn't tell if it was a vessel or if it was solid, so she ordered an ultrasound, thinking it's likely just where a vessel crosses over my trachea.
Welp. I got a call shortly after the ultrasound yesterday, and it doesn't appear to be a vessel, but rather a solid nodule directly above the thyroid isthmus. They've ordered a CT with contrast, so my sketchy kidneys are already screaming at the thought while I wait for insurance authorization.
I feel like I need to get my affairs in order because I'm certainly going to die of metastatic thyroid cancer soon. UGH. The wait will do me in.
15 notes · View notes
neurodivergent-nurse · 11 months
Text
I’d like to talk about the duty of care that comes with working in any “helping”/caregiving profession.
Recently a horrible hate crime was committed at a Las Vegas high school. A nonverbal autistic Jewish boy was attacked and came home with a swastika carved into his back. His service dog’s equipment bag was also damaged.
His aide, who claimed to have been with him all day with no separations, said he’d had a good day with no meltdowns. His school also claimed no knowledge of what had happened. If the aide had truly been with the kid all day, this could not have happened without them knowing. So one way or another, they are lying.
Needless to say, this disturbs me.
It also reminds me of an incident several years ago in Arizona, in which a profoundly disabled woman (the press described her as “vegetative” but I hate that word) in a long term care facility was raped and gave birth. The staff at the facility claimed to have no knowledge of the pregnancy until she went into labor, a fact I have a hard time believing. Did no one auscultate her abdomen? Did no one notice weight changes/redistribution? Did no one notice any of the other physical changes wrought by pregnancy, including the absence of menstruation, for nine months? Because I’m a nurse working with a similar patient demographic, and it would take serious neglect to miss all that.
The thing that disturbs me in both of these cases is the complete lack of care exhibited by the responsible people involved. It seems clear to me that in the woman’s case, and very likely in the boy’s, the people responsible for providing care were instead habitually neglectful. They got away with it because their client had no way of reporting the neglect. Because of that neglect, horrible things were done to the people under their care—and when those things came to light, they were too busy covering their own asses to care about the people who were hurt.
I am developmentally disabled. I am autistic and have ADHD. Autism, specifically, is one of the four disabilities considered eligible for Department of Developmental Disabilities (DDD) services in my state. I work with developmentally disabled clients in a DDD-funded facility, so I have the unique opportunity of regularly attending trainings focused specifically on preventing the neglect and abuse of clients with the same disability as me.
It hits close to home, you know?
How many caregivers out there are just like this—lazy, neglectful, in the habit of not properly supervising or assessing their clients, giving half-assed care because they know they won’t be reported? How many never get caught because nothing catastrophic like this happens to their clients? How many people in caring professions think it’s ok to treat a living person like a product to be moved or a machine to be maintained with the absolute barest amount of care possible, just a job to do to get paid? I understand these jobs tend to be understaffed and underpaid and burnout is common, but there is never an excuse for neglect like this. Never.
If you can’t be bothered to give a shit about the human life you’ll be responsible for, then don’t get into a caring profession. Don’t. Don’t become a nurse, a teacher, an aide, whatever. I’d rather deal with understaffing than with neglectful coworkers who put my patients in danger. You can half-ass a lot of jobs. You cannot half-ass a job where you are responsible for someone’s life, safety, and wellbeing.
55 notes · View notes
nursinggeek · 7 months
Text
So, I'm already using Grian's "Third Life is a series on YouTube. What color is my shirt?" in teaching how to approach tricky exam questions. (Literally, "What part of this question is telling you that Third Life is a series on YouTube?" has become an actual thing I ask my students during quiz reviews once they've seen and discussed the clip.) Here's the thing: it's a very useful way of demonstrating distractors in questions in a non-nursing context that makes them laugh ... so they remember it.
Now, I think I'm adding today's Imp & Skizz Podcast episode "The Thief of Joy" to my syllabus in the spring. That class is specifically about making the shift from student nurse to professional nurse, and one of the big things new grad nurses run into (besides all the systemic problems that make it harder than ever to give them a solid start) is comparing themselves either to more experienced nurses or to fellow new grad nurses who pick up certain things faster. Almost everything we'll be discussing is nursing-specific in that class, and hearing from a COMPLETELY different realm (Minecraft, drumming, poker) about how comparison can shut you down or hold you back ("I suck!") or can be used as a way to grow ("There's something I can learn here!") is something I think has the potential to be really helpful.
Giving them another reason to roll their eyes and say, "She's such a weirdo. Who assigns stuff like this in nursing school?" is just a bonus.
25 notes · View notes
macgyvermedical · 7 months
Text
I don’t know what nursing or medical student needs to hear this, but you need to take a first aid course if you have not done so. Preferably a higher level one like wilderness and remote first aid or even an EMT if you can spare the time.
Someone is going to get suddenly hurt or sick and everyone is going to look at you. And you’re not going to know why you have no idea what to do because all you’ve been doing for the past few years is learning how to take care of hurt and sick people.
The thing is, knowing what to do in the moment, being able to keep yourself and your patient safe while not making anything worse is a completely different skill than taking care of someone in a hospital or nursing facility. And its okay if you never want to do remote or on-scene medicine as a job, but everyone is going to expect you to be able to for some reason so getting some first aid skills is going to really help you in the coming years. Promise.
451 notes · View notes
whatsyouremergency · 11 months
Text
Happy Nurse’s Week, you bad asses.
39 notes · View notes
populationpensive · 1 year
Text
Working in an ICU...
...Means that you meet people on the worst day of their lives.
A colleague of mine said this over the weekend, which was a very rough weekend for me in so many ways. My patients were complex and very sick. The families were challenging. So. Incredibly. Challenging.
I see the worst things that can happen to people. Every. Day. I am able to push it out most of the time. Some times, there is a true shit storm of circumstances that emotionally bankrupts me. That was this weekend for me.
I think it is sometimes easy to forget how vulnerable patients and families are in the ICU. It's easy to forget it is the worst day of their lives. And when these families can't control the illness of their loved one, I think they look for literally anything they can control. Sometimes that results in verbal abuse about policies, staff, and treatment. It can be so hard to deal with this. The amount of patience it takes is astronomical.
I will freely admit that I am very detached. You almost HAVE to be to a certain extent to DO the job. But even the most detached people have a breaking point.
It makes me grateful for every family that simply thanks me for my time. Every colleague that "gets it". Every person willing to listen to me when I am going home from work.
So, to all you health care people that struggle with this as I do, we've got this. Some how, we've got it.
50 notes · View notes
sweetdreamspootypie · 1 month
Text
So I need to do an education session teaching the other ward nurses something (for my professional development portfolio stuff)
Should.... should I do it on queer stuff?
Queer stuff 101: the gingerbread person and holy shit please stop misgendering the trans patients and using slurs
Inching closer to teenage me's aspirations
Problem.is that if I don't just chose something then I'm going to overthink way too much. I never could do assignments on time.
I would probably have to get proper sources for things besides "source: trust me"'
Technically none of those are related to the quality improvement groups I've been put on but. Eh.
9 notes · View notes
Text
Tumblr media
33 notes · View notes
silverstars87 · 4 months
Text
So I finished all 16 rounds of chemo and now I’m first case on Monday 12/4 for bilateral nipple sparking mastectomies, right port removal, and bilateral expander placement with a cellular dermis.
I Wish this wasn’t happening.
I cry a lot. And my husband won’t even speak to me for the past 5 months.
13 notes · View notes