I need some help in understanding something.A patient who has diabetes and has glucose levels in the that range from 200's for breakfast and 300-400s during the day with Lantus BID + sliding scale AC/HS. The MD ordered for a controlled carb diet, but dietician believes that his diet should not be modified, because the problem is that the patient is not absorbing glucose. My concern is that the insulin is being adjusted constantly, and his sugar is still ranging as above. I believe that an endocrinogoly consult should be done for the uncontrolled glucose levels. My thought is that the body is already unable to produce insulin, and if it is unable to absorb glucose, wouldn't there be another underlying issue??
The patient has advanced dementia and therefore forgets when he eats. He complains of hunger around the clock. Does not snack in between, unless staff gives him a snack.
Nov 16, '15
Sounds like insulin resistance without knowing his insulin doses. If he's type 2 then he makes insulin but it's not working with the glucose like it should. If he does snack what is he snacking on and what time of the day. How much sliding scale coverage does he get? He may need a set premeal/nutritional insulin dose along with a correction scale and a little more Lantus. Why is the lantus split bid, does he get a large total amount for the day? Is he only on insulin, no oral regimen. What type of setting is this, inpatient or long term care?
Here's a posting almost two years later! A ketogenic diet, high good fat like coconut oil, low carbohydrate will help any person with Alzheimer's dementia or Type II diabetes. Sounds like he needed a caregiver at his home.
I hope all went well with this gentleman.