Carb counting and insulin in LTC

Specialties Geriatric

Published

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.

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We do Carb counts with our surgical patients. The MD writes the order for it such as::

Humalog Insulin wm or ac Carb coverage 1:10(meaning 1 unit per 10 grams of CHO.) I have seen anywhere from 1:8 to 1:15. You as the nurse will need monitor meal intake to dose appropriately. We are lucky because our dietary tickets that come with food have the ampunt of CHOs per dish. Sounds like you will need to get a nutrition reference for your facility and coordinate with your dietary dept for lists of upcoming foids on menu so you dont have to look up foods every meal.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I do not see how carb counting will work in LTC when the nurse has 30 residents and 15 of them are diabetics. Sorry, but the typical LTC nurse does not have the time to monitor all those meals.

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I can see how it could be challenging however, arent there CNAs and other staff that that can be delegated to? I eould not like to do it that way, but the formula its self doesnt take any longer to figure out. The resident ate all his potatoes and half his roll, with no other carbs. So, for example it would be something like 45 grams of CHO,=3 units if they were on a 1:15 ratio. I work in a hospital, so its less patients but in a LTC you would have ro get creative to make it work

Also, there has to be MD orders. Do all the residents have the same doctor?

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I work in a hospital, so its less patients but in a LTC you would have ro get creative to make it work

Lol!! We ARE experts at being creative in LTC. I can't speak for all, but personally I have my hands full of it every shift. Ever tried to convince a demented patient that they are not the governor? Perhaps one who calls 911, weekly, to report that they have been kidnapped? Calling on the cell phone that the RP insists the 90+ yr old patient MUST have in the event of an emergency. And that's on a slow night....3-11.

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Yes, Ive worked in Alzheimer's units, regular units, and have done nurmerous roles from CNA to SIC to Activity Director. Never been an RN in a Snf though. It is not easy, but I loved it. I went to hospital for more money as a CNA.

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Do you trust your CNAs to really LOOK at each tray and decide if they ate 1/2 of the 1/2 cup of corn,, etc or do your nurse check them herself? How do you figure in the chips, candy bars etc that they get from the snack machine and food family and friends bring in unknown to u?

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The whole trusting of the CNA issue is a part of you rights of delegation. You as the nurse have to make that judgment call on an individual basis. Also, the cips and candy bar thing shouldn't come into play if it isnt consumed with meals because again, you have to go with the MD orders which will only usually require you to give coverage at meals not snacks

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Specializes in Gerontology, Med surg, Home Health.

Probably none of you are old enough to remember when we gave sliding scale insulin based on a urine dip strip. Those were not fun to use or figure out. Still, I am not sure I'd trust anyone but a licensed person to determine how many grams of carbs a resident ate to base a sliding scale on.

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Specializes in LTC,Hospice/palliative care,acute care.

The trend in LTC has been liberalizing diet restrictions in the elderly.. We just had an inservice with a rep from a well known company that manufactures insulin,I'm interested in seeing how it plays out.

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We have had liberalize diets for a while and they have worked well with routine sliding scale. Our FNP has decided we are starting the carb counting. Our Med nurses are so busy now with everyone on numerous meds and vitamin supplements, I worry about a mass exodus of LPNs. So many of our diabetics are very elderly with many comorbidities including dementia of varying types and the latest trends I have been reading on is to not hold these people on a tight Blood sugar. We have only had 2 out of the 48 with an elevated A1c in the past 3 months. Just really trying to see how many LTCs are tightening up on the BS in this manner. I can see it being good on the Rehab side but on the LTC side??? Thanks for all the comments so far.

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Specializes in LTC,Hospice/palliative care,acute care.
So many of our diabetics are very elderly with many comorbidities including dementia of varying types and the latest trends I have been reading on is to not hold these people on a tight Blood sugar. .
Do you have a palliative care program? If not, you need one. At least get the families involved-this is contraindicated in the population that you describe. We have a small rehab unit and we also have some younger LTC residents who are where they are due to poor life choices and now the damage is done.They are non-compliant no matter what we do and they will die that way. As you said this approach will be of benefit to a certain segment of our population but not our frail super elderly folks.
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