One day, I was talking with a few nurse friends about nursing school, and we all found ourselves saying the same thing: “I wish someone had told me that!” We realized that while nursing education gives us an essential foundation, many of the most valuable lessons come later—through experience, thoughtful mentors, and caring for real patients. That conversation inspired this monthly series. Each post shares a few practical pearls I wish someone had told me early in my nursing career. They’re not meant to replace textbooks, policies, or sound clinical judgment, but to offer the kind of practical wisdom that helps nurses think more critically, recognize subtle warning signs, and provide safer care.

Our first topic is Diabetes.

Diabetes

Diabetes is one of the most common chronic conditions encountered in correctional healthcare. Most nurses learn the basics of diabetes management in nursing school, but there are some lessons that only seem to come with experience.

One of the first things I wish someone had told me is that the blood glucose value is only part of the story.

New nurses often focus on the number itself. Is it 250? 350? 450? While those numbers matter, they are only one piece of the clinical picture. A blood glucose of 350 mg/dL represents hyperglycemia and requires attention, but the nursing response should not stop with the number. How does the patient look? Are they eating and drinking? Have they been taking their medications? Are they experiencing nausea, vomiting, abdominal pain, excessive thirst, confusion, or weakness? Has there been a significant change from their usual glucose pattern?

Over the years, I have learned that changes in condition are often more important than a single glucose reading. A patient whose blood glucose is consistently elevated may require a different response than a patient whose glucose has suddenly increased and is now accompanied by new symptoms. The number is important, but the patient is always more important.

Another lesson I learned is the importance of knowing the provider’s treatment plan. Many patients have sliding-scale insulin orders, hyperglycemia protocols, or specific provider instructions that guide nursing actions when blood glucose values fall outside the desired range. Correctional nurses should be familiar with those orders and understand when provider notification is required.

The opposite problem can occur as well. While elevated blood glucose levels often receive considerable attention, hypoglycemia can develop quickly and may present with subtle symptoms. Irritability, sweating, shakiness, confusion, unusual behavior, or difficulty concentrating may be the first signs that a patient’s glucose is dropping. In a correctional setting, those symptoms may initially be attributed to withdrawal, behavioral concerns, or noncompliance unless healthcare staff and custody staff remain alert to other potential causes, including hypoglycemia.

One final lesson I wish someone had taught me earlier is the importance of listening when patients tell you that something feels different. Many patients who live with diabetes recognize changes in their bodies long before a blood glucose reading confirms the problem. A patient who says, “My sugar feels low,” or “Something isn’t right,” deserves careful evaluation even when the numbers do not initially seem alarming.

After years in correctional nursing, I have come to view diabetes management as much more than responding to a laboratory value or glucometer reading. The glucose level provides important information, but the real assessment begins when we consider the patient sitting in front of us, their symptoms, their history, and what may be contributing to the change.

The most important lesson may be the simplest one: treat the patient, not just the number.

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What about you? What’s one thing you wish someone had told you about caring for patients with Diabetes? Share your “I wish someone had told me…” pearl in the comments below. Your experience could help another correctional nurse recognize a subtle warning sign, avoid a common pitfall, or provide even better care. Let’s learn from one another.