Diabetes
What causes diabetes and the damage that it causes in the body?
Diabetes mellitus is a chronic disease that occurs when the body doesn’t produce enough insulin or cannot utilize insulin properly. This causes glucose (sugar) to build up in the blood instead of moving into the cells. Most elders have Type II diabetes, which occurs when the body does not produce enough insulin or cells ignore the insulin that is present.
Glucose in the blood normally attaches to red blood cells. When the glucose is high, it tends to harden the red blood cells, which damages the lining of blood vessels, which in turn, can lead to clots. Uncontrolled diabetes is an important risk factor in the development of cardiovascular disease and its subsequent deadly consequences.
What are the symptoms of diabetes and how should I expect for them to be treated in the nursing home?
Most people have few outward symptoms if blood sugars are in normal range.
Symptoms of high blood sugar associated with diabetes include extreme thirst, excessive hunger, urinating heavily, headache, weakness, full bounding pulse, fruity smell to breath, hot, dry, flushed skin, shortness of breath, blurred vision, drowsiness, mental confusion, unconsciousness, and high blood sugar by finger stick.
Symptoms of hypoglycemia (low blood sugar) may occur from over-treatment or by skipping meals. Symptoms include crankiness, weakness, confusion, nervousness, sweating, complaints of hunger, dizziness, shakiness, rapid heart rate, rapid shallow respirations, cold, moist, clammy, pale skin and possibly unconsciousness. A low blood sugar by finger stick will be noted.
If low blood sugar occurs, the physician should have standing orders or have approved a policy and procedure related to treatment. Juice or regular soda are often given, but if the person is unconscious this is unsafe and can lead to aspiration (sad to say this has happened). If unconscious, the resident should be given other medications which are either placed in the cheek or given by injection. If this is not effective, the physician is notified and 911 is called.
What responsibilities does the nursing home have in caring for diabetes?
Nursing home staff should be aware of symptoms and attempt to keep blood sugars within normal range without dangerous spikes of high and low blood sugars. This includes monitoring the resident’s blood sugar routinely four times daily or more often until a stable pattern is established. Thereafter, monitoring the resident’s blood sugar daily to weekly is indicated, depending on stability. The three-month blood sugar, which is called the hemoglobin A1C, should also be monitored.
Proper diet and adequate fluid is critical for control. If your loved one does not eat his or her meals, he or she is at risk for dangerous drops in blood sugar. Also, your loved one should be given a bedtime snack to prevent a dangerous drop of blood sugar at night. Many nursing home staff “forget” to give a bed time snack and record meal intakes. Such practices have resulted in dangerous consequences for some. Also dangerous elevations in blood sugars can occur when activity staff “forget” about your loved one’s diet restrictions and give sugary snacks during an activity.
Some nursing homes do not utilize special no added sugar diets and choose to use medications to control blood sugar to enhance quality of life. If your loved one cannot make his or her own decisions, and you wish for a no added sugar diet, then you have the right to request this. If blood sugars cannot be controlled with proper diet, taking oral medicines or insulin will be indicated.
Nursing staff should protect your loved one from infection. Infections cause rapid and dangerous changes in the blood sugar. Extra blood sugar monitoring should be provided if infections occur.
What are the complications of uncontrolled diabetes?
The many consequences of diabetes include heart disease, strokes, kidney disease, and vision loss (diabetic retinopathy). People with diabetes should see an eye physician once a year to assess for visual complications.
In addition, diabetic neuropathy can occur. This is nervous system damage caused by toxic levels of blood sugar. Most often it occurs in the hands and feet. Symptoms include loss of feeling in the effected extremities or painful tingling. The toes may start to bend upward causing more injury to the tops of the toes and making the ball of the foot more prominent and more at risk for injury due to pressure. The risk for injury to the feet is high. Any injury to the feet can cause a wound not to heal and lead to amputation. You should expect that your loved one with diabetes be protected against pressure sores and cuts.
Medicare pays for the podiatrist to give foot care, so a referral can be made for nail trimming. Many injuries to feet that have led to deep wounds have occurred due to routine nail trimming done incorrectly by nursing home staff in patients with diabetes.
Nursing home staff members need to thoroughly wash and dry the feet every day in those who have diabetes and inspect the feet for injury due to those residents having difficulty feeling when damage may be occurring. Corrective shoes and other devices may be needed to minimize injuries and maybe even prevent some complications from occurring.
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