Diabetes in long-term care

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By Dale Mayerson and Karen Thompson

The number of people with diabetes has doubled in the past decade and continues to rise.   The majority of seniors with diabetes have Type 2 diabetes, which occurs when the pancreas does not produce as much insulin as the body requires, or when the body does not respond to the insulin that is produced.   When the cells cannot use the glucose, it can rise to dangerous levels in the blood and causes damage to organs and tissues.

 

Why the concern?

Diabetes is a progressive disease that can affect the eyes, kidneys, nerves, heart and circulatory system.  Yeas of high blood glucose levels can impact the heart and lead to heart disease and other conditions of the heart.

For older adults, there are other negative effects of ongoing high blood sugar, such as incontinence, higher risk of infection, poor healing and confusion. Diabetes has been linked to schizophrenia and dementia, as well as dental problems, hepatitis B, and hypothyroid conditions.

Goals in managing diabetes

The goals for people with Type 2 diabetes are controlling blood glucose, reducing or maintaining a healthy body weight, and preventing complications.  For people living in the community, there are diabetes education centres that provide a team approach to provide education and support to clients. Clients are taught to perform self-monitoring at home, including blood sugar checks and symptom monitoring.

The type of support for people living with diabetes in long-term care homes may be quite different.  Seniors in long-term care may be physically frail, have other medical diagnoses, live with cognitive or emotional deficits, and take multiple medications.  They are not able to manage their diabetes themselves and require support from health care professionals in the home.   Medical care, meals/snacks, activities and medications are planned according to each resident’s risks, limitations and needs.   The individual condition of each resident is considered, since frailty and other health factors may preclude strict adherence to guidelines used for younger or more independent adults.   These differences in meeting needs of the elderly are in place to enhance their quality of life: residents must be comfortable and safe in all possible ways.

Many homes are taking a ‘liberalized diet’ approach with seniors, which allow residents with diabetes to eat the same foods as everyone else.  This improves their quality of life, and research has shown that a less restrictive diet provides more enjoyment of meals with fewer restrictions, and a better intake of nutrients for overall better health.

Residents in long-term care still have their blood sugar monitored as required to improve control.  Long-term care staff know that “normal” blood sugar levels may be higher for seniors, in order to avoid the risks associated with low blood sugar.

Registered Dietitians in long term care homes monitor resident progress towards their goals including checking blood glucose levels and providing individualized meal plans for residents whose blood glucose levels are not stable, or who require a special diet for complications of diabetes, such as end stage kidney disease, dialysis or other health issues.  Dietitians, nurses and other health care professionals monitor and assess residents quarterly, or more frequently as required and develop care plans that meet residents’ individual medical and health needs.

Low blood sugar, also called hypoglycemia, can be dangerous for seniors.  Frail seniors may be less aware of the symptoms of hypoglycemia.  This is called “hypoglycemia unawareness”.  When blood sugar falls too low, the effects can include trembling, sweating, headaches, weakness, dizziness, confusion, and fainting, all of which can further lead to falls, concussion or broken bones.  These can be serious and life-altering problems for frail seniors, and therefore it is essential to ensure that blood sugar does not drop to an unsafe level. Homes should have established protocols in place for treatment of hypoglycemia.

Residents in long term care deserve the best care possible.  It is important to treat seniors as individuals, and not as a homogeneous group, since their needs, desires and levels of physical and mental health are each unique.  Optimal care is provided when the multidisciplinary team in a long term care home works collaboratively in providing the best possible quality of life for each resident with diabetes including monitoring and  controlling blood sugar.

Dale Mayerson B Sc RD CDE, and Karen Thompson, B A Sc RD are Registered Dietitians with extensive experience in Long-term care.  They are coauthors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians of Canada.

 

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