Balancing Act

Wilted Daughter

90 year-old mom's in SNF for short-term while I am on medical leave. Her glucose levels are always elevated when she goes to SNF (the cons of the stay) and it's a long road back to decrease her #s when she comes home. She's been there since 4/8 and I learned yesterday her #s are very high, so I sent the doctor and director of nursing faxes, emails to request changes like strict controlled carb diet and slightly (1 or 2 units) increase to insulin. In the past they have done nothing but issued referrals for when she comes home (pass the buck), but this time I am requesting that they handle it (duty of care). My position is that they at the very least should be able to maintain glucose levels by diet/medicine, especially when provided a sound option for resolution before admission.

I was thinking of bringing her home early, but it will make matters worst for me, because I have a medical procedure scheduled (the reason for her being there) and can't take care of her and myself during my recovery.

Don't want to elevate the matter but...

Wilted Daughter

https://alzconnected.org/discussion/64839/balancing-act

"I can do anything but not everything" - Unknown

mommyandme (m&m)

As a SKILLED nursing facility they should be caring for her medically in that way too, IMO. That’s frustrating for sure. But, you gotta take care of you! Don’t bring her home if possible. So sorry!

Wilted Daughter

Thank you M&M,

I grappled yesterday with the issue, but this morning spoke with a nurse who informed diet is changed and suggested insulin increase up to "3" units for consistently high #s. Numbers fluctuate, it's part of the disease but she is prescribed medicines to address so we don't have to reinvent the wheel each time there is a spike.

I've been told they can handle it, and I will make sure they do without sacrifice health (hers or mine).

Quilting brings calm

I don’t know what type of insulin she takes, or how often. My spouse takes the long acting once a day kind for type 2. The specialist has it set at 50 units. But told him to drop it by 5 or more because he was having lows in the middle of the night. So you might call the doctor and ask how much to change it

M1

Would just comment that at ninety, low blood sugars are much more dangerous to her than highs.

Wilted Daughter

M1,

From experience the balancing between how high is too high and how low is too low it difficult to navigate and a 'art'. When her glucose #s are within 'normal' range she complains of being weak/dizzy. I found her sweet spot and communicated that to SNF.

In my opinion her Dementia makes managing her Diabetes much more difficult due to communication issues. It's all about the diet and proper dosing, but coming from a home environment into a group environment there are changes that must be made through explicit communications with staff. So, we discussed when #s are consistently (which is subjective) over 300 administer 1-3 units of the short-acting insulin. Although, she hasn't had to use the short-term insulin since fall 22 and upon admission was at 18 units once a day, there is room for increase. Her diet has be changed and I told her to eat, don't worry and let the medicine do it's job. Food/Medicine is a double edge sword with Diabetes and Dementia is just a sword.

*It seems the more people involved the less help there is😕

M1

Yes I do agree it's a very, very difficult combination. So tough. It gets so hard to know when you are treating the numbers or are you really treating her. I once had a very demented, elderly patient who was completely comfortable and fine even with glucoses of 400-500 with absolutely no symptoms. So it was best to just leave her alone. The hardest battle I had to fight was to convince the nurses not to check her sugars any more.

Wilted Daughter

M1,

You have probably move on to other conversations, but I want to say that not checking #s is a recommended in certain situation. I hoped that if we kept the diet at all times, and current insulin levels she would self correct when she comes home. The problem is if her #s are too high she faints, after that it takes longer to return to normal.

Thanks for your comments! 🙂