No more intervention
So my father is a type 2 diabetic, stage 7 c or d(per hospice), possibly in heart failure and on Hospice for 4 weeks. He is in a memory care facility and eats well(too well, big boy:). They have to work hard to get him up and to breakfast or at least get some OJ in him every morning because of low blood sugar. Hospice nurse goes twice a day because he use to require insulin 2 x per day. Its never high enough in the morning for them to give it to him or at least it hasn't for a few months. Last weekend Hospice nurse called me and said they couldn't get him awake, do I want him to go to the hospital? I said I would rather he didn't. She said EMS could come and give him something to get his blood sugar up. I said OK not really knowing any different. After talking to the EMS supervisor he made me realize I could of let him pass peacefully in his sleep. Those are my words not his. He just wanted me to know since I wouldn't send him to the hospital that he could go into cardiac arrest if it went down to 31 again. I spoke to hospice and they agreed I could have done that and he would have died in his sleep. Unfortunately the nurse that was there last weekend had never worked with my dad so she didn't suggest it. The facility(not hospice) is not real happy about my decision. My dad is a favorite. I talked to one of the Hospice nurse about what would happen if he doesn't get any insulin and it gets too high/ketosis. She said it would be similar to it being so low but I got the impression it would take longer for him to pass. Currently they are still giving him insulin in the late afternoon/evening because it gets real high. I've discussed it with family members and they are all in agreement for him to pass as peaceful as possible but honestly the sooner the better. Its breaking all of our hearts to see him like this. I want to do what's best for him. I am his POA and he has a DNR. I would like to know everyone's thoughts on this?
Comments
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I'm so sorry you're at this point. If I were to ever find myself in this situation with my mom in MC, I would want her to pass as peacefully as possible. That has been her wish since before she had dementia. I would want the same for myself as well.
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I woukd continue with the afternoon insulin shot - but I would work with hospice to NOT wake him up if he is sleeping- or unconscious. The hospice nurse that asked if you wanted him to go to the hospital or have EMS called basically ignored the hospice concept of giving comfort care rather than curative care.
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If it was my dad, all meds including insulin would stop
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My husband is T2 diabetic. He’s only late 4, early 5, but at 7 c or d I would stop meds with the exception of for comfort.
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I’m so sorry you are in this situation. You are facing some incredibly difficult decisions. Regardless of what you decide, go easy on yourself. There is no “right” answer. Do what you think is best and try not to beat yourself up over the decision you make.
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@LisaLH
The answer is the one your dad would have chosen for himself.
Making the choice to optimize the odds of a peaceful passing is what many of would and have chosen. While I can appreciate that staff do become fond of their residents, your father's wishes should be honored.
If you have concerns about the MC in what are likely his final days, you might consider a hospice house instead.
HB5 -
My father would be so mad to know I've let him go this long and spent so much of his money but until he went on hospice there wasn't much I could do. He was a tightwad:)
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Can I ask why you would continue the insulin? I know nothing about diabetes so any information is helpful. Thanks
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I guess I would consider it a comfort thing. What was Hospice’s reasoning for continuing the insulin shots? I assumed they had one.
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Honestly not sure. I'm new to this but I know the hospice nurse I met with first, when discussing about taking him off all insulin, she said I could but she said something to the fact of intervening if it got to high. I know nothing about Diabetes and wish I could find a nurse that knows a lot about it so I could ask questions. Sometimes I feel between the facility and hospice they are trying to keep him alive. My cynical husband says its all about the money.
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@LisaLH
Do you have a PCP you could ask about this?0 -
I don't unfortunately. I am going to find someone. Just like today the hospice nurse called me and said his blood sugar was over 100 the last 2 days. That hasn't happened in months. I think the facility is feeding him before bed to ensure his blood sugar isn't low. They have done that in the past. Not sure how I feel about that. Seems like an intervention of sorts.
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they should stop long term insulin and monitor for short term insulin only if blood sugar goes too high. Only for comfort purposes. Going too low is not as worrisome for comfort purposes IMHO. I’m not a nurse but that’s what they did before my DH passed.
Prioritize Safety & Comfort:The goal shifts from long-term blood sugar control to avoiding symptomatic hyperglycemia and, crucially, avoiding dangerous hypoglycemia.Reduce Treatment Intensity:As dementia progresses, insulin regimens should be simplified, and in many cases, discontinued, particularly if the patient has become frail or is in hospice.
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How "high" does his BG get? Over 200 would be very high for a healthy person, but is unlikely to do him harm. Personally, I wouldn't give insulin unless BG was over 400. Harm is more likely from low BG. It sounds like his body isn't processing the insulin properly, causing BG to bottom out. There are also different types of insulin, with different rate of onset and duration. Do you know what type of insulin he's getting?
I'm a retired nurse if you have any questions
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A peaceful passing is a beautiful goal. That’s what I want for my PWD too. I agree with other commenters here: you are making very hard decisions. Go easy on yourself. You are doing everything thoughtfully and compassionately.
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Sorry it took me so long to reply. He has a lantus injection every evening, not sure of mg. He takes Glipizide 5 mg and Pioglitazon 45 mg once a day in the morning. He was getting a injection in the morning but his blood sugar hasn't been above 100 in a few months so they stopped it. Any thoughts are appreciated.
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We were given this option with a family member with Alzheimer’s in late stage 7, and this is what I can tell you. The family member, her son, who was her DPOA was not ready to allow her to die. He could not live with the guilt of this decision. She passed four months later. This decision has to be what you can live with and what she would want. His mother was never able to verbalize her wishes. I think if she had, he would have let nature take its course and end her misery.
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I have his advance directive and it is clear what he wants. I don't even need it to know. He would absolutely hate the life he is living now and would be willing to suffer in pain if it meant he passed sooner. I think I'm having problems with not getting a good answer on what happens to him if his blood sugar gets too high. I know he will pass from it but will it be awful for him? That's where I'm getting conflicting stories. I'm going to talk to another hospice company and go from there.
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"I think I'm having problems with not getting a good answer on what happens to him if his blood sugar gets too high."
See
I'd word your requests carefully, there is a difference between wanting to follow your Dad's wishes and being considering as trying to hasten events- but you don't want a staffer getting Adult Protective involved and then instead of being able to see your Dad -you end up needing lawyers.
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Without knowing how high the BG gets, it's hard to know if he's in danger. BG above 200 will cause damage, but it's slow damage to blood vessels and nerves. Acute illness may develope with BG above 250, but not always. It sounds like low BG is a greater concern, as it can be acutely dangerous. If it was my family I would stop diabetic meds unless BG was above 200.
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Thank you.
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Commonly Used Abbreviations
DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
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