Elderly forgetful diabetic, need advice on improving complaince

[Keld401]

I have elderly pt (70's) that I have been working on diabetes education with. He is really sweet, wants to be compliant and tries very hard, but is very forgetful. He rarely remembers to take his insulin (70/30 30units bid) and when he does he may take 2 or 8 or 20 units. Has cataracts and poor vision, had him draw up 30 units and he had a lot of difficulty and only drew up 21 units, so I prefilled a week's worth of insulin syringes, last week he only used 3 of them, this week only 1. He has gotten better about checking his cbg and cutting down on sweets, ranges have went from 30's-600+ to 50's-300's, over the past month. I have tried several different kinds of charts and signs with spots for am and pm cbg, when insulin given, and when meds taken, taped them to his fridge, but between his eyesight and forgetfulness they don't do much good. His wife isn't in great shape and isn't much help w/ reminding him to take insulin. He is very receptive to education and really wants to get is sugar under control, as his kidneys are already showing damage. I just don't know what else to do to get him to remember how/ why/ when to take the insulin. He is also forgetful w/ taking his po meds but has improved w/ using the chart and BP has been better controlled, at least until today when he forgot his meds again and BP was 210/88. Any ideas on charts, signs, different types of glucometers, etc that I can use to help him remember to check cbg before meals, take insulin as ordered, and take meds? Thanks a bunch!!

Kelly

[OkieeRN]

I have elderly pt (70's) that I have been working on diabetes education with. He is really sweet, wants to be compliant and tries very hard, but is very forgetful. He rarely remembers to take his insulin (70/30 30units bid) and when he does he may take 2 or 8 or 20 units. Has cataracts and poor vision, had him draw up 30 units and he had a lot of difficulty and only drew up 21 units, so I prefilled a week's worth of insulin syringes, last week he only used 3 of them, this week only 1. He has gotten better about checking his cbg and cutting down on sweets, ranges have went from 30's-600+ to 50's-300's, over the past month. I have tried several different kinds of charts and signs with spots for am and pm cbg, when insulin given, and when meds taken, taped them to his fridge, but between his eyesight and forgetfulness they don't do much good. His wife isn't in great shape and isn't much help w/ reminding him to take insulin. He is very receptive to education and really wants to get is sugar under control, as his kidneys are already showing damage. I just don't know what else to do to get him to remember how/ why/ when to take the insulin. He is also forgetful w/ taking his po meds but has improved w/ using the chart and BP has been better controlled, at least until today when he forgot his meds again and BP was 210/88. Any ideas on charts, signs, different types of glucometers, etc that I can use to help him remember to check cbg before meals, take insulin as ordered, and take meds? Thanks a bunch!!

Kelly

It sounds like he needs to be a daily insulin pt if he and/or his family cannot consistently give him the shots. He clearly is not able to pull up the insulin on his own and forgets with the prefilled syringes. If he doesn't have children or church family or someone able and willing I think making him daily is the safest choice.

[amoLucia]

Is there some kind of alarm-clock type device out there that could remind him of his med time? Maybe some type of telephone reminder that could be programmed to ring at a pre-set time? With all the high-tech gizmos avail, somebody somewhere should have something to intervene. (And if there isn't, some entrepreneur should invent one!!! HINT HINT HINT).

I have a question --- home health aides come out for ADL visits with a nurse for intermittent supervision as per a care plan. Is there any home services where a certified med tech CNA can come out to draw up a bunch of insulins in advance for pt to use??? And then some kind of reminder-alert system could be the reminder for him? Would a LifeCare Geriatric Case Manager type know of any of these kind of services?

I realize his/her forgetfulness/memory contributes MAJOR BIG TIME to any successful remediation but I'.m trying to think of something. I feel for this couple; and for you trying to help:hug:

[Keld401]

I have a question --- home health aides come out for ADL visits with a nurse for intermittent supervision as per a care plan. Is there any home services where a certified med tech CNA can come out to draw up a bunch of insulins in advance for pt to use??? And then some kind of reminder-alert system could be the reminder for him? Would a LifeCare Geriatric Case Manager type know of any of these kind of services?I realize his/her forgetfulness/memory contributes MAJOR BIG TIME to any successful remediation but I'.m trying to think of something. I feel for this couple; and for you trying to help:hug:

My next thing to try is setting an alarm clock or maybe his cell phone to remind him. I have been prefilling his needles w the right dosage but he forgets to use them! Or he takes what he thinks he needs. Either way its not effective enough. I also considered a big dry erase board that's easy to see. I have heard of med planners that come w an alarm, anyone know where to get one?The home care assistants would be good, but they can't afford it. :-( the social worker is going out next week to see if she can do anything. Making him daily isn't a long term solution since he takes insulin bid, and i don't think indefinite daily visits to administer insulin is covered by Medicare.Thanks guys!

[OkieeRN]

The problem with alarms is that they don't always align with eating. Medicare does pay long term if the pt is unable to draw up or administer reliably his/her own insulin and there is no willing/able caregiver available. It has to be documented on every note though. And unfortunately it doesn't pay much. It wouldn't hurt to try the alarm and/or alarming med planner before you consider taking on a BID pt. Good luck, let us know how your interventions work :)