Frustration to Fuel: Why I Chose To Become A Nurse Practitioner (a diabetes management story)

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Anger. Frustration. 

These powerful emotions are often catalysts for change. One of my pivotal moments came on Labor Day weekend in 2017, when I argued with a hospital attending. 

Let me take you back.

I was rounding on a medical-surgical unit at a 471 bed regional medical center. That Friday afternoon, a nurse saw me turn the corner and relief washed over her face. “Katlyn, I need your help.” 

My Role: An Expert in Diabetes Management

At the time, I was a certified diabetes care and education specialist—a master’s prepared registered nurse with advanced skills and training in diabetes management. I was the only one for the entire facility. The nurses knew me well. 

All newly hired nurses attended the interactive four-hour diabetes course I taught each month. I kept the unit “survival skills” toolboxes stocked, taught nurses how to use demo insulin pens and home glucometers, and updated hospital policies to improve patient safety and blood sugar time in range. 

The hospital where Katlyn worked

I consulted with patients using insulin pumps, those who were newly diagnosed with diabetes, and those admitted with diabetic ketoacidosis (DKA). I worked closely with hospital attendings and endocrinologists too, recommending medications for discharge or insulin dose adjustments during hospitalization. 

They relied on me. 

The Situation

On this day, the nurse quickly filled me. She was caring for a frail, elderly woman admitted with pneumonia. For the past three days, her blood sugars had remained in the 300 to 400 range despite following the correctional insulin scale on her chart. The attending doctor had ignored the nursing team’s repeated requests to adjust her insulin orders. They felt powerless to help.

Blood Sugar Targets

For reference, blood sugar between 70 to 140 mg/dL is considered normal for someone without diabetes. In diabetes management, aiming for normal blood sugar in someone with diabetes often overshoots the mark—causing dangerous lows that could be deadly. We don’t target normal anymore, but it’s pretty close, 80-180 mg/dL for most individuals with diabetes. 

The American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) recommend a target blood glucose range of 140–180 mg/dL for most non-critically ill hospitalized patients, and starting insulin when levels remain above 180 mg/dL [source 1, 2].

Our patient’s numbers? Double that (Think 300-400s!).

Why High Blood Sugar Gets a “Meh” Reaction 

The sad reality is that many healthcare providers get frantic for low blood sugar (less than 70) but don’t bat an eyelash when blood sugar goes up. Why? Time. 

With low blood sugar, we see the effect rapidly—the brain needs a constant supply of glucose (aka sugar) to function, without it we start feeling and acting weird. For an average adult, the brain demands roughly 130 grams of glucose daily or 20-30% of the total body’s glucose consumption at rest [source]. We use even more for thinking! 

When most people think about high blood sugar, diabetes complications come to mind. We’re talking about amputations, dialysis, blindness, and so on. Fewer people think about what we call macro-vascular (aka big blood vessel) complications like heart attack, stroke, and peripheral artery disease though the risk for these events increases too.

Yes, all of these scary things can happen, but they take a lot more time to actually happen, so many patients and healthcare providers put their worry about these possibilities on the backburner. Okay, so how much time are we talking here? According to one study, around 24 months (that’s right, two years!) when they looked at people with newly diagnosed diabetes and the median timeframe for complication(s) to develop [source].

The Short-Term Impact

Let’s get back to our patient case. This frail, elderly woman is in the hospital because of pneumonia, and yeah, she happens to have diabetes. Naturally, the focus is going to be helping her keep breathing by killing off the bacteria in her lungs with antibiotics. If it takes 2 years to see big blood vessel complications, what’s the harm in letting her blood sugar ride in the 300-400 range for a few days?

First, she’s going to feel like garbage. Short term elevations in blood sugar make you feel incredibly tired, super thirsty, and pee more often. Many people also notice their vision gets blurry off and on. Later symptoms might include nausea, vomiting, and belly pain. While this doesn’t sound too bad, drawing a large amount of fluid out of the body to remove extra sugar can lead to dehydration, confusion, dizziness, and falls. 

Next, elevated blood sugar leads to increased risk of infection and delayed healing—getting control of her pneumonia infection may take even longer. Longer stays in the hospital not only increase costs but put this frail woman at risk for a second infection on top of her pneumonia (think hospital super bug) or even worse, sepsis—a full body blood infection that can be deadly [source]. 

Finally, elevated blood sugar causes hypercoagulability—a fancy way of saying the blood gets sticky and increases clot formation which raises the chance of heart attack, stroke, and other vein clots [source]. You all know any one of these events can lead to death or permanent disability. And it’s preventable! 

The Confrontation

I knew the dangers of elevated blood sugar, even in the short term. Fueled by frustration and determination to advocate for this patient, I tracked down the attending. He sat in an alcove, eyes glued to the computer, fingers clicking away rapidly on the keyboard. I introduced myself, explained my role, and voiced concern.

He barely looked at me. “I’m aware of her sugars. I’m fine with it.”

I tried again, recommending a safer insulin regimen and citing hospital policy and clinical evidence. His response? Louder, sharper: “Hypercoagulability? You don’t think I know what I’m doing?!” He dismissed me and ended the conversation.

Already standing at this point, I turned on my heel and escalated my concerns up the hospital chain of command, only to find they were already gone for the long Labor Day weekend. I did what I could, left voice mails, submitted a hospital safety report, and sent off an email to the Chief Medical Officer whom I was on a first name basis, as a final plea for help. 

The nurses felt powerless, because they were. Myself included. 

Sadly, the frail, elderly woman with pneumonia did not see improved blood sugar levels during her hospital stay. They remained dangerously high until she was discharged home. What happened to her after this I’ll never know. 

The Aftermath 

Katlyn teaching about insulin pumps

When leadership returned, my messages were finally heard. The Chief Medical Officer, a strong advocate for diabetes care, spoke directly with the attending about the risks of ignoring hospital policy. The case became a hospital-wide learning opportunity and safety campaign for safe blood sugar management.

And me? I never wanted to feel powerless again. This was a turning point, a spark that joined with several others. It fueled my decision to become a nurse practitioner—so I could prescribe insulin myself. 

And that’s exactly what I do today. 

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This blog story was written by Katlyn Agosta, MSN, APRN, FNP-C, CDCES. She is a wife, mother of two, and proud direct primary care nurse practitioner. Her specialty is diabetes care, education, and empowerment—from the lens of her own type 1 diabetes experiences.

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References 

Adare, A.F., Tiyare, F.T. & Marine, B.T. Time to development of macrovascular complications and its predictors among type 2 diabetes mellitus patients at Jimma University Medical Center. BMC Endocr Disord 24, 252 (2024). https://doi.org/10.1186/s12902-024-01782-3

American Diabetes Association Professional Practice Committee; 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S321–S334. https://doi.org/10.2337/dc25-S016

American Diabetes Association Professional Practice Committee; 13. Older Adults: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S266–S282. https://doi.org/10.2337/dc25-S013

Cara L. Thompson, Kelli C. Dunn, Meera C. Menon, Lauren E. Kearns, Susan S. Braithwaite; Hyperglycemia in the Hospital. Diabetes Spectr 1 January 2005; 18 (1): 20–27. https://doi.org/10.2337/diaspect.18.1.20

Carr ME. Diabetes mellitus: a hypercoagulable state. J Diabetes Complications. 2001 Jan-Feb;15(1):44-54. doi: 10.1016/s1056-8727(00)00132-x. PMID: 11259926.

Dhatariya K, Umpierrez GE. Management of Diabetes and Hyperglycemia in Hospitalized Patients. [Updated 2024 Oct 20]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279093/

Goyal MS, Raichle ME. Glucose Requirements of the Developing Human Brain. J Pediatr Gastroenterol Nutr. 2018 Jun;66 Suppl 3(Suppl 3):S46-S49. doi: 10.1097/MPG.0000000000001875.