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Question:

From Appleton, Wisconsin, USA:

Our daughter, age 10, diagnosed Type 1 three years ago, tests her blood sugars at least four times a day. Two to three years ago, my mom, 84, was diagnosed Type 2. About 5 months ago, my dad had to place her in a very good, small, licensed residential group home for people with Alzheimer's disease. She receives two insulin injections of R daily at about 8 A.M. and 4:30 P.M. Although she is served three meals a day, plus snacks, the amount of food she actually eats at each serving can vary quite a bit.

Because of our daughter's strict control, I have a problem with the fact that my mom's blood sugars are monitored only once a week, per doctor's orders. Since being placed at the facility, my mom has slipped quite a bit. Among other things, we've all noticed that my mom naps more, some days almost constantly. Progression of her Alzheimer's, transition to a new home, lack of stimulation, and depression are among the explanations for her lethargy. It's occurred to me that low blood sugars also could be a cause.

Even though her blood sugars were not necessarily monitored on a daily basis when she lived with my dad, is it unreasonable to believe that my mom's blood sugars should now be monitored before every meal and at bedtime, at least for a while to rule out poor diabetes control as being a problem? Or am I off-base and biased because of the regimen we're taught to follow with my daughter?

Answer:

I can certainly empathize with your situation as my mother also went through Alzheimer's disease and nursing home care. She did not have diabetes as your Mom, but I think you have the right expectations of care. If her blood sugar is too high, as you and I both suspect it is, she is more forgetful, sleepy, perhaps blurred vision, having to go to the bathroom more -- all the symptoms of high blood sugar. I suggest you discuss this with the head nurse at the nursing home and set your expectations out with your mother's doctor. No matter that she has Alzheimer's, she deserves a good quality of life and to feel the best she can. No, she probably doesn't need the "tight" control that your daughter has, but reasonable control is not too difficult and will help your mother.

KS

Additional comments from Dr. Quick:

If your mom's blood sugars are reasonable (no hypoglycemia and only rare sugar levels over about 200) after about three days of regular 4-times-a-day testing, then I'd suggest that the testing program be cut back to twice daily while healthy, alternating between two patterns: (1) check before breakfast and supper on odd days (for example, January 31 and then February 1st) and (2) check before noon meal and bedtime snack on even days (for example, January 30 and then February 2nd). The doctor should be notified if the blood sugar is way too low or way too high (for example, below 50 or above 400); hypoglycemia treatment should be initiated by the nursing home staff for any sugar below a more moderate number, like 80 or 90, to help avert super-low sugars. If she becomes acutely ill, for example with a fever, cough, or urinary symptoms, then the testing should automatically be increased to four tests daily.

A concept like this facilitates gathering almost as much information as four tests a day, when averaged over a long period of time. And it is a pattern that any nursing home, even with minimal or rotating staffing, should be able to follow.

WWQ

DTQ-19991118070016
Original posting 6 Jan 2000
Posted to Blood Tests and Insulin Injections

  
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Last Updated: Tuesday April 06, 2010 15:09:08
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