Carb counting and insulin in LTC

BrandonLPN, LPN · Aug 18, 2013

Are any of you doing Carb counting versus sliding scale insulin? We are about to start this and have lots of concerns as to meal percent actually ingest by the resident, who monitors the percent eaten of each food and who counts the carbs and figures the formula for the insulin. Any help will be appreciated. We have appro 110 residents with 48 diabetics.

So out of those 48 diabetics, how many actually need novolog? I'm guessing at least half your diabetics are only on glucophage and/or a long lasting basal insulin. Carb counting would be pointless on these residents.

Of your diabetics who are on novolog, how many are sliding scale?

In a LTC setting, it's perfectly acceptable to have straight, scheduled doses of Novolog (say 10 units with meals and at HS) given provided the meal was eaten and the BS was at least 150.

For relatively stable diabetics, evon those on novolog, there isn't always a need for a sliding scale, let alone carb counting. I have over 20 diabetics on my hall alone, and only 3 or 4 of them are on a sliding scale.

Apart from everything else, carb counting is overly invasive in a LTC setting. It's too much of a disruption in the lives of our residents. This is their home, remember. The only possible scenario where carb counting would be indicated in LTC is a scenario with a brittle diabetic whose blood sugars are out of control and the medical provider has decided counting carbs is the only solution.

For a facility to up and say "Let's just switch all the sliding scales to carb counting" shows a profund lack of common sense.

BrandonLPN, LPN · Aug 18, 2013

Holey Moley, that post ^ is full of typos. Sadly I seem to be past the time for edits.

kmarie724 · Aug 20, 2013

I've only had a resident who did carb counting once. She was A&O and there for a short term stay after surgery. She did carb counting at home and continued with her same regimen at my facility. But no, we do not routinely use carb counts for our residents.

withasmilelpn · Aug 21, 2013

Wow - would not want to so that on my unit. Very few CNAs I could trust with that. Our dining room is far off the unit and Residents don't return timely for meals.

However, we are under construction and will be soon having a dining room/kitchen on our unit. (Supposed to be a 'household ' type model.) There it could be doable.

Wish i had some advice for you, but honestly not sure what to tell you. Sounds like it could be quite a hassle. Best of luck, let us know how it goes.