My mom is living in an ALF Memoery Care Floor. She is a type 1 diabetic. Every morning when they check her sugar she is extremely low. We have been working with her doctor to adjust her insulin, however the really solution would be for her to eat more or any of her dinner and her evening snack (which they do bring her). I have given them lists of what she likes to eat, I have advice them to sit with her a few moments to chat. Do I really need to go there everyday at dinner to make this happen? Today I went there just a few moments after dinner started, she was the only one at her table without a plate. They said she did not want anything but drank a gluerna so she should be good. I said no, let's get her a plate and see what she will eat. She at the vegetables and fruit, drank a glass of milk and then an extra banana. She said no, but eat some just because it was in front of her. I total them to bring her a PB and Jelly and another banana for her snack. Lets see if I get a call in the morning. Any advice, as I am afraid the ALF will be asking her to move out. (She likes it there and as finally seems settled after a year and half of moving her from place to place.)
Talked to a palliative care doctor, can't say how I really feel about that. He was very understanding and mostly asked questions. He wants to give it a few days to see where mom is at and then he can recommend a plan.
Emotionally and Physically tired plus just unsure of what is happening.
A lot has been going on with you and your mom lately. Glad she is being cared for.
How exhausted you must be - hospitals and waiting for hours
I hope you can rest
How's mom tonight ?
They after that the nurse tells me the doctor recommends palliative care. So what does this mean, nurse says she will have doctor come talk to me. I am tired and have no fight left in me to deal with this right now.
Here I sit, waiting basically by my self since mom just can't understand.
I too agree- keep her higher at night for awhile. Treat her infection, push fluids too. You can add Glucerna if she is eating like a bird to supplement.
Hope she feels better soon! Get some rest, daughter.
Mom's primary doc and endocrinologist don't agree either. I am leaning more towards the primary care who also says lets let her run a little high and not to give her any insulin when she is lower then 175. Which is really the evening one since she was having the lows in the morning. I guess we have to see what happens after this infection clears up.
Well the primary insisted again and we had him start the 5 units a day. Needless to say father started having issues. He was staying dizzy, confused, couldn’t gain energy (as much as 83 year old can have), and was losing his balance. We moved his shot from mornings to night when he would probably eat more. Finally he had a fall where he bumped his head. After that, I begged them to take him back off the insulin because that was the only thing different.
We haven’t had any other incidents. With that being said, he does have an appointment with a neurologist to make sure nothing else is going on medically.
Hope she gets the help she needs.
Hope it works out, TC, try to get some rest til tomorrow.
So sorry to hear about your mom. Sometimes, it does seem like when it rains it pours, but, no, it's NOT selfish to need a break. it's the smart thing to do, but, I understand how you want to get your mom's blood sugar managed. Managing type I is so challenging. I have cried many times from frustration. It's pretty horrid, but, it's even more difficult when you are trying to do it for someone who has dementia. It sounds like your mom handled it herself since age 16. That's pretty impressive.
Have you heard about the insulin called Afrezza? It's a mist that you inhale through the nose. It's very short acting and taken with meals. I wonder if your mom is able to inhale it, it might help with her highs through the day. I might ask if her doctor is familiar with it. It doesn't hang around long and so it might help avoid her overnight lows. Just an idea.
Also, I'd explore getting your mom on a daily, steady diet of exactly what she likes to eat and figuring out what she needs in insulin. It might be boring to eat the same thing most days, but, she might like that, if it's her favorite food. That might be a way to prevent the lows and highs. If this blood sugar can be managed, maybe her other issues will follow.
6/20 -53
6/21 - 203 (morning after night visit)
6/22 - 179
So hopefully finally things are going better.
Have you tried Glucerna? Many diabetics like Glucerna. This is made specifically for diabetics. Also I ask my diabetic patients that tend to drop in the middle of the night to try to eat a high carb snack - peanut butter on a graham cracker, Skinnypop popcorn, things of that sort. Carbohydrates and protein.
She needs re-evaluation of Trujeo. I would ask to go back to Levemir. In my experience Trujeo has inconsistent results with many patients. Levemir works pretty well and is a lot less expensive as well.
I know you have said you are working with an endocrinologist but the endo needs to change something.
The continuous glucose monitor is a device planted subcutaneously, it beeps when the BS is high or low, & the cartridge needs to be changed weekly. I have a 29 y/o juvenile onset patient now that uses it and while it is very accurate, she says it takes a lot of monitoring.
The continuos dermal patch mentioned above can monitor for two weeks or so and is a good alternative. If your mom doesn't remove it.
Has she been started on prednisone or had any cortisone injections lately say, for joint pain? Any sign of underlying infection? Those will cause blood sugar fluctuations.
Many diabetics get insulin intolerant over the years as well and need higher doses but that is a slippery slope with an elderly person living in AL.
Just throwing out suggestions, not trying to second guess you here.
Review her glucometer for blood sugar results at what time of day.
Does the AL keep a log of when the BS was checked and the amount of insulin given? Do they truly check her BS 4x/day?
Are they giving the correct insulin? I'd look at the bottles myself just to check, but I am a RN and I troubleshoot everything anyway.
Also if possible ask the staff to keep a good diary and take the results to a registered dietician and she/he can tell you how many grams of protein and carbs are necessary specifically for your mom. What is her weight? BMI?
Keep us posted.
I noticed that as adults get older, their taste buds adjust where they will eat saltier or sweeter things but instead of adding sugar or salt, add flavors by spices and herbs.
I do encourage you to speak with someone at her location to see if they have a volunteer program to see if anyone besides you can be present with your mother.
I know Arby's not the best choice, just one of her favorites so I know she would eat some.
Let see how she is when the check her at 7 am.