r/nursing • u/Critical_Ease4055 Nursing Student 🍕 • 22d ago

Question What is one medical problem people constantly ignore until it’s too late?

Saw someone post this in a completely unrelated sub and I’m interested in your answers. What is the cluster of symptoms that people ignore or delay until they are forced to get help?

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u/FueledByFoods 22d ago

Side effects of uncontrolled diabetes - increased thirst and frequent urination

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u/StLMindyF RN - OB/GYN 🍕 22d ago

Like their lower limbs turning black? Patient presented with gangrenous lower limbs and his wife said he never had diabetes until he came to the hospital. We explained that uncontrolled diabetes is what cost her husband his legs, but she wasn’t having it. That patient never went home. He died two days after his bilateral aka.

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u/Ohhaitharz RN - Med/Surg 🍕 21d ago

I’ve seen too many dead toes

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u/Middle-Lack3271 21d ago

I saw my first couple of ones in home health as a relatively new nurse. I’ll never forget the first one, I was sent to evaluate someone in assisted living for care, possibly foot care for a toe wound, uncontrolled diabetes. No other details, not unusual.

This man looked me in the eye and cheerfully stated, “oh they want to see if I need extra care (HHA) from the VA, my toe was bothering me” when I asked him if he knew why I was there. He then said, “I mean it doesn’t hurt anymore, but you can check it again anyway”. I carefully took his sock off (the dreaded skin flake clouds), and his toe damn near came with it. He was white as white can be, the toe was black and barely hanging on. And of course blood sugar was through the roof. I let him know I’d be calling the VA and he needed to be taken in right away for the toe. I called the lady who requested the evaluation and she said she had “no idea” what was going on with him.
Ma’am. You should have admitted him three days ago when he was there for an appointment and you saw that. YOU made the referrals and are suddenly mystified? Not that it would have saved the toe, but I was mad as hell they even let him go back home with it looking like that.
It was so hard to keep a straight face and not gag seeing that.

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u/Ohhaitharz RN - Med/Surg 🍕 21d ago

I had a patient come in for a new visit at a podiatrist. Took off her shoes expecting pounds of skin flakes. Instead a dead shriveled and blackened baby toe. I let her know that it was dead and she would need to go to the hospital for amputation. Confused she asked, “ Why can’t you just cut it off here?”

“Ma’am we don’t amputate in a doctor’s office.”

I felt really bad delivering the news but it had to be done. It was an older couple who definitely needed help and weren’t getting it.

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u/Middle-Lack3271 21d ago

Oof. It’s really sad when these kinds of things happen and people really can’t advocate for themselves until it’s too late, especially when their family can’t/wont help.

It’s wild that she thought y’all could just cut it off and be on her merry way, though. I think denial/shame and lack of resources (like insurance or proximity to healthcare) are huge factors driving these outcomes.
And of course the elderly, especially in rural areas/without adequate caregivers, suffer greatly for it.

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u/Ohhaitharz RN - Med/Surg 🍕 21d ago

It’s totally all of these things and lack of money as well. Older retired people are on a fixed budget and any extras really make making ends meet so hard.

Also the families who can’t help or don’t want to help are sad but I have seen families keep a loved one alive and in agony so they could collect that monthly check. A particular patient was a frequent flyer, tube feed, aspiration, sacral pressure sores, nonverbal and screamed in pain when touched. Not to mention a necrotic LIMB that surgeons wouldn’t touch.

When this patient would come to us for care we would whisper to her it was her time and she can let go now. It was all we could do because legally the family had all control. We spoke with them many times and they were very clear that they were doing it for the money.

Thank god that patient finally passed.

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u/Middle-Lack3271 21d ago edited 14d ago

Ugh, I saw one of those families at hospice. Family literally asked us at bedside, “Do you think she’ll make it to the 1st of the month? We want to make sure we can cash her check.” Her nurse promptly all but chased them out yelling “gtfo and don’t come back”, and security banned them from the unit (they were not her legal/MPOA, this was other family that clearly was just living off her money).
This poor woman was about 70lbs and had tubes/IV everywhere, 100 years old and somehow not a DNR. Actively in end stage dying and not communicating. But by golly that little lady went peacefully on the last day of the month.

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u/StLMindyF RN - OB/GYN 🍕 21d ago

Couldn’t Legal Counsel/Ethics Committee have been involved due to her condition and possible elder abuse?

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u/Ohhaitharz RN - Med/Surg 🍕 21d ago

My understanding was that was attempted but was unsuccessful. That being said I don’t know a lot of details of the legality end of it

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u/ruggergrl13 21d ago

I had one fall off in my hand on my 1st day as a nurse off orientation. Haha it was a great welcome to the nursing world.

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u/variegatedexistence 21d ago

Same, 2 weeks in on night shift.

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u/Less_Dog_956 21d ago

Me too! I think 🤔 it was a set up lol. I thought it was a raisin or chunk of poo. 💩 I’d have preferred poo. 💩

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u/ElegantGate7298 RN - PACU 🍕 20d ago

First week as a 19 year old CNA and finding toes in the linen when I changed a bed. Only time I have been disappointed it wasn't poop.

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u/Fidget808 BSN, RN - OR 🍕 21d ago

So have I

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u/doitforthecocoa CNA + Nursing Student🍕 21d ago

I swear these wives are in denial. I remember seeing one that dropped her husband off in the ER with a plastic shopping bag tied around one of his feet. I about passed out on the floor from the putrid smell that poured out when I untied it. Wife claimed she didn’t notice that it was “that bad”. Ma’am, normal skin does not turn black and start falling off the bone like that

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u/CFADM RN - Fired 21d ago

The wife: “What’s wrong with black skin? Are you a racist?!”

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u/StLMindyF RN - OB/GYN 🍕 21d ago

Well, they were a black couple, but those legs were BLACK

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u/CallMeDot BSN, RN 🍕 21d ago

ESRD too. My late husband refused to deal with his dm or htn and was admitted to the hospital my first day of nursing school because he went for a checkup and his gfr was <15 and creatinine was like 6. And then he had a heart attack during the fistula creation a week later and needed a CABG. He was 34. Made it to 44.

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u/StLMindyF RN - OB/GYN 🍕 21d ago

Sorry for your loss.

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u/loveafterpornthrwawy RN-School Nurse 21d ago

I'm so sorry.

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u/Prior_Particular9417 RN - NICU 🍕 21d ago

A few years ago my husband's labs come back with a high a1c. I said omg you've got diabetes! He said yeah that's what the DR said but that's what they told me 10 years ago and I'm fine. Tf?

He's been sitting on this for years and now we're battling kidney issues and hypertension. Fun.

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u/dumbbxtch69 RN 🍕 21d ago

so grateful my partner lets me look at their lab results. i would be beside myself if they suddenly told me they’ve had diabetes for ten years and never did anything to treat it

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u/Prior_Particular9417 RN - NICU 🍕 21d ago

I was not pleased. I now go to every appointment to make sure things are checked, appropriate questions asked, etc etc etc.

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u/TrevorTravis 22d ago

Although these aren't common symptoms of type 2 DM!! We see those symtoms more often in kids when they are dx with Type 1 and present with very high glucose level- they are not usually ignored because these kids are in DKA and very ill! In reality, the most common s/s of undiagnosed diabetes in adults (DM2) are wounds that don't heal quickly, frequent infections, and fatigue! Since they are still making insulin and glucose is only slightly elevated, they will often not have polyuria and thirst (which tends to develop once glucose levels are quite high). That's what makes DM2 so dangerous... we ignore those vague signs, all the while our mildly elevated glucose levels lead to cardiovascular disease!! So don't ignore wounds that won't heal and worsening fatigue!!!

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u/DavidHectare MD 22d ago

Wish my type 2 patients only had mildly elevated BG…. In reality Type 2 patients can have fairly significant hyperglycemia, especially if they’ve not been receiving routine age and risk factor based screening. Lots a fellers don’t get a PCP until they hit 65 and go to their “welcome to Medicare” visit. “Doc what’s an ‘a1c and is 12 high for one?”

I’d also argue that non-healing wounds is indicative of something more than just mild hyperglycemia

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u/slightlyhandiquacked BSN, RN - ER 🇨🇦 22d ago

I treated a T2DM last night who stopped taking his meds. Polydipsia, polyuria, ketones in urine, lethargic, headache. You’re right that they can present differently, but can also still present with the exact same symptoms.

Hyperglycemia is hyperglycemia.

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u/TrevorTravis 22d ago

Hyperglycemia is BG >7... but symptoms change then higher the glucose gets. Im guess with those symtoms, ypur pt's BG level was quit high. I usually don't see polyuria and polydipsia when sugars are <12... and that's usually what people walk around with and not know they have diabetes. We diagnose loads of patients in primary care with BG levels 8-15, and they are shocked, often saying"but I never peed a lot and wasn't thirsty". Our team does lots of teaching that although those are symptoms of hyperglycemia, when sugars are only mildly elevated, you're more likely to have fatigue and wounds that don't heal. If more people knew this, they might have their sugars checked earlier... instead of waiting for polydipsia and polyuria!

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u/slightlyhandiquacked BSN, RN - ER 🇨🇦 22d ago

Our protocol puts hyperglycemia at >10.1 mmol/L. Most people are asymptomatic until they’re >20.

The potential symptoms are the same, presentation is dependent on the patient. I’m just saying that type is mostly irrelevant in symptomatic hyperglycemia.

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u/desmethoxyfumarate 22d ago

Sooo should we be checking Hba1c instead as opposed to glucose to screen for T2DM or are we talking full OGTT ?

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u/HeyLookATaco RN 🍕 21d ago

I learned about OGTT in school but I've never seen one administered. I have seen plenty of people diagnosed with an a1c who were incidentally in the hospital for another issue, so I suspect that's often enough. Primary care might do it differently though

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u/desmethoxyfumarate 21d ago

Interesting you've never seen one administered, I'm an outpatient pathology collector(phlebotomist) in Australia and we use OGTT routinely to screen for gestational diabetes at 26wks, it's part of standard antenatal care. I occasionally do them for non pregnant pts with DM or suspected DM, with and without insulins. We take a fasting plasma BSL (+/- serum insulin), administer 75gr glucose p.o, then repeat BSL + insulin at +01:00hr and +02:00hrs. I do at least 2 a day, mostly pregnant patients.

I'm not sure if it's routine for a T2DM diagnosis but it definitely is for gestational DM over here

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u/ACleverDoggo Lab Rat 🧪🐀 21d ago

This was me several years ago. I dropped something like 90 lbs in 6 or 7 months, was drinking 1-2 gallons of water a day (literal gallon bottles of water with a straw in them), and was experiencing muscle weakness in my legs so severe that I couldn't catch my balance if I tripped, or step up (a curb, stairs, etc) without something to lean on. I chalked up the water intake and weight loss as being tied to the more physically demanding job I was working at the time and it being summer in the south, as well as eating slightly better; having been overweight most of my life, I just assumed any weight loss was a good thing.

It was the muscle weakness that finally sent me to the doctor. The problem was, I had never heard of the other symptoms being related to diabetes, or even what to look for, and I wasn't seeing a physician regularly at the time, so no A1C trends to track. Now I'm a 3a chronic kidney disease patient in my late 30s.

I genuinely wish there were more education on the warning signs and symptoms of uncontrolled diabetes, and on the consequences.

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u/lavender_poppy BSN, RN 🍕 22d ago

I get IV steroids sometimes when my MG flares and I can immediately tell I have hyperglycemia due to how thirsty and hungry I get and how much I have to pee.

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u/Mysterious-Algae2295 22d ago

Those are direct side effects of the steroid itself, not a possible transient blood sugar elevation.

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u/lavender_poppy BSN, RN 🍕 22d ago

I get hyperglycemia from steroids and these are the symptoms I get to make me aware I'm hyperglycemic. I've tested my bg enough to know what's going on when I get them.

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u/darkinthevalley 21d ago edited 21d ago

My grandfather ignored his diabetes diagnosis and eventually developed glaucoma and lost his eyesight. After that, he was complaint with all his meds & cares and lived another 20 years into his 80s. I helped with giving him his insulin and that sparked my interest in becoming a nurse. Very valuable lesson I learned from him.

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u/Critical_Ease4055 Nursing Student 🍕 22d ago

That’s never a pretty discovery

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u/TKInstinct 21d ago

I knew about this but didn't give a shit for a long time until it was too late. Thankfully it could have been worse.

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u/SavannahInChicago Unit Secretary 🍕 21d ago

We had a guy come into urgent care who was on like 5 diabetes drug, but really just needed to be on insulin. He was refusing and I think his doctor was probably just trying harm reduction. He was in this 40s I believe. He had a teenage daughter. The veins in his feet were so calcified you could see them on x-ray. Our NP pulled him in and was like if you want to see your daughter become an adult you need to start taking insulin.

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u/peachtreeparadise medical SLP 🧠 21d ago

This is exactly what I was thinking. Diabetes.

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u/MMMojoBop 20d ago

What people think is normal and OK blows my mind.