Diabetes management in LTC

Specialties Geriatric

Published

I have been working in LTC for as long as I have been a RN--about 1.5 years. I have worked in two facilities, and I have run into the same problem with my sliding scale diabetics--actually all of my diabetic elders--in that no matter what aides I have working with me, they will bring my diabetics to meals without informing me so I lose my opportunity for a pre-meal accucheck.

I have tried updating the care plans, verbally instructing my aides at the start of my shift, and even posting a sign reading "Elder must be seen by nurse BEFORE meals" but it is still a daily struggle.

I do have a good routine down for the floor I work, but my sliding scale elder does not always eat at the same time every day. Often she will rise at the start of my shift while I am taking report on a different floor (I work two floors with ten elders each).

Does anyone else have this problem or do I just suck at managing my diabetics?

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Specializes in Gerontology, Med surg, Home Health.

Do these elders really need a sliding scale? If the MD or NP addresses the basal insulin needs, many of the sliding scales can go away. It's not a good way to manage insulin dependent diabetics. It's not easy for you and it surely isn't fun for them to get stuck several times a day.

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She went off sliding scale for a time but she ept spiking into the 300s after breakfast and her a1c was 9ish so she went back on. I wanted to increase lantus but MD disagreed with my approach.

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Specializes in Gerontology, Med surg, Home Health.

How old is she? The docs around here and in the world of academics don't think HgB A1C should be kept to the same numbers in older people. The theory is we tend to drop our blood sugars at night because we haven't eaten. Our brains need sugar to function and old people don't need to lose any more brain cells than they already have---yes that wasn't written in a scholarly manner but....

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Specializes in LTC.

We have been having this same discussion with our current medical director. He is new and has started a new policy requiring nursing to request primary md's to review current med lists and reduce as much as possible. Most of the focus of care for the long term resident is comfort cares . The only residents we have that have a sliding scale are the short term rehab residents.

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Specializes in Gerontology, Med surg, Home Health.

What a wonderful medical director!!

Just be aware that many stable diabetics are put on sliding scale insulin in the hospital because they have some sort of infection or are on prednisone. Try to get that discontinued as soon as possible. If they are going to need it when they get home, make sure they are able to use a glucometer, figure out how much insulin to give, and have the sight, dexterity, and cognitive ability to do it. If not, teach a family member.

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Specializes in LTC.

Of course!! I have seen it many times when a patient is on a an antibiotic or prednisone and they are on a temp sliding scale until the treatment is complete . I really do like our new medical director. He is all about the patients and keeping them comfortable.

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Specializes in Nursing Home.

I work at a nursing home that has many many diabetics who are on CBGs to ss. Every night I'll get CBGs of 300-400mg/dl. The biggest challenge to me is trying to get these residents to comply to a diabetic diet and dietary don't help the cause. There giving diabetics HS snacks of cookies, PB&J sandwiches. I find a lot of these diabetics are stuck in there wags and not interested in anything the Nurse has to say. Our MD is very liberal when it comes to Accu checks to ss. We had a meeting regarding the subject a time back. He refuses to d/c a ss of the resident a recent CBG above 180mg/dl

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