Follow
Share

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.)

This question has been closed for answers. Ask a New Question.
Find Care & Housing
1 2 3
Tattoochick, can you take your mom to her endocrinologist or PCP to re-evaluate her insulin needs? You have posted about several episodes of your mom dropping her BS, at various times of the day. Maybe the doc needs to cut it back or change it. Do you know what type of insulin it is? Is she on sliding scale coverage according to her BS? If so that's hard for her to manage. I am just trying to figure this one out.
If one had to choose, it would better to have high blood sugar than all these drops for her.
You can bring her glucometer in with you to the doctor visit as the machine keeps a history of prior BS for them to review.
I would make sure she had fast sugar even hard candy sources available at all times or glucose pills in her room.
It sounds to me she may need her insulin needs adjusted as she may be prescribed an amount from when she ate more but her intake now has changed.
Just a thought. My mom ate like a bird for the last couple years of her life. She wasn't diabetic though.
Please keep us posted.
Helpful Answer (3)
Report

@Shane I understand what you are saying and have been working with both her endocrinologist or PCP to figure things out. Both however really feel that if we could get her to eat more it would help.

The ALF is trying to get her to eat again at 8 pm but she is at her worst in the evening, stubborn and just does not care.

I feel like I am just wating everyday for the ALF to say she can not live there anymore. This would mean a Nursing Home for her. I don't have anything against NH. Over the past year and half mom has been in 3 different ones in the local area and each cared for her. However, she gave up in them. She would not get out of bed, worse eating problems, did not want to bath. Plus contently call me in the middle of the night to say I was keep her in jail and it was not right and just not nice things.

At her current ALF she does get up, she dose (except dinner and night snack) she baths and will participate in actives. If she has to go back to a NH I fear she will give up again and not live very long.

It has been a long month and a half with this issue and I just want to figure it out. I even tried talking to her about what would happen if she doesn't try to do better with eating, but you can't reason with dementia.

My own depression and anxiety is bad right now, and I am being told to take a few days away, but it is hard to do that when everyday some one is calling me about her. I don't think there has been a day from January 2016 when I became her caregiver that I have not had to speak for her, run an errand, pay a bill, or many other things.

I really do need a break, but there is always a fire to put out with her. Sigh.
Helpful Answer (1)
Report

For example; tonight I am going to her ALF at her snack time 8 pm to do an ACCUE check. Why because the doctors want to know what it is and there is no "nurse" in the building at that time to do it. But they are leaving me the stuff and I can do it. SO CRAZY.

This is every ALF in this area. There is a nurse the aids can call overnight to ask questions or inform them of a situation but not in the building. So I am going to do it. Trying not to go today, but just this evening.

Trying to work and earn some money to pay my bills. OK know I am rambling.

Just wondering if caregiver with a diabetic dementia has seen this before and can give advice.
Helpful Answer (0)
Report

Could she afford to have someone come in to assist her with meals? I know it is galling to have to consider that when you are already paying the AL, but it would give you a break and perhaps enable her to stay there.
Helpful Answer (0)
Report

Tattoochick, your sort of situation always makes me wonder what happens to little old ladies and gentlemen who don't have a competent and concerned relative to supplement their care.

So if this ALF, and as you say every other facility in the area, has residents with Type 1 diabetes they're on their own with it? It seems bonkers. No disrespect to you to think that surely if you can do this blood glucose check then an aide can be trained to.

I'm really curious. What happens if God forbid you get taken out of action?

I'm sorry you're worried about her having to move, as well. Has the facility actually started making noises about that possibility, or have you discussed with them how they're getting on with your mother more generally?
Helpful Answer (0)
Report

@Countrymouse The ALF has no other issues with her. She is very quite and compliant. They just keep saying they are concerned, and don't want her to wind up in a coma. Of course I know they are concerned with an liability on them. That is what make this frustrating is that she is happy there and her behavior is good for them.
Helpful Answer (0)
Report

@cwillie Intersting idea, it takes away to warm up to new people so not sure if that would work. I have a few cousins in the area and ask them to visit and even to it at a meal time. That has only happened once in the 5 months she has lived there.
None of her friends visit either, I know they are just uncomfortable with dementia. But I know she would love to share a meal with them.

The whole it takes a village is true for our aging seniors as well. Everyone seems to run for the hills as we age and don't offer support.
Helpful Answer (2)
Report

I am a Type I diabetic. Taking care of insulin levels is a full time job. Since your mom is not able to do that for herself, it's vital that it be addressed. You are right to insist on her behalf.

When you say her blood sugar is low in the a.m., how low do you mean? Is it 70 or 40? Low blood sugars should be addressed by her doctor immediately. It's not a let's give it more time thing. It's urgent. So, I'm not sure why the insulin doses have not been reviewed by her doctor and addressed.

It might not be practical, but, there are Continuous Glucose Monitoring devices that alert when the blood sugar goes too high or too low, but, it requires time, energy and attention and it doesn't sound like the staff is up to it. Also, your mom's dementia might cause her to try to remove it.

What are your mom's A1C numbers? They should reveal if she's running too low overall.

I might have a team meeting with the Memory Care staff. They should understand how a dementia patient may say they don't want a plate of food, but, they really do and would eat it, if placed in front of them. And, there comes a time when most dementia patients need hand feeding and they may need to sit and offer it to her by feeding her.

There is just a lot of special dementia care that a Dementia Care unit should have, that sounds like yours doesn't. Can you check to confirm that they are indeed a licensed Dementia Care unit? Their practices sound odd, to me. My LO is in a licensed Memory Care unit and it operates much differently from what you describe.

If things can't be controlled, I'd explore if mom needs skilled nursing with her doctor.
Helpful Answer (3)
Report

@Sunnygirl1 Mom can feed herself, just needs the encouragement to do it or the food she likes. Over the past month the aides seem to have gotten better trying other food options when she is not eating during the day. I think she would be angry if anyone actually tried to feed her. It is the night time that is the issue that refusing to eat just because she does not want to, which does happen with dementia.

Her lows have been in the 40s and 50s and it is not a wait and see attitude. During the day she is closer to 200. I speak daily with her Primary Care Dr. and the nursing director at the ALF. Everyone is trying to figure out why she awakes up so low. Let me tell you she is very functional at those numbers, you don't realize she is low until you test her.

As I stated earlier she had been in a skilled nursing home and her behavior is horrible, refusing to bath, get out of bed and eat at all. Seriously the nurses don't have time for that, they just checked her every few hours and would give her insulin if she was high or a glucose shot if it was low. And yes she was in three different skilled nursing rehab places and they all did the same thing. So I can understand why my mom was depressed in them. So yes a NH would be able to constantly monitor her diabetes with out limitations but she would just give up and I would be lucky to have her around for Christmas. I want to have some peace and happiness in these last few years, not just to lay in bed and stare at a TV.
Helpful Answer (1)
Report

Perhaps there's a community college with a nursing program where you can solicit for a little help for someone to be with mom during the evening meal - my mom doesn't warm up to new folks either and I have caregivers with her 12 hours a day - bringing a new one into the rotation takes some time
Helpful Answer (2)
Report

Okay. The thing about maintaining the blood sugar with insulin is that it works over time. Are you positive that she is a Type I diabetic? I say this, because there are some Type II's who take insulin. You can get Type I or II at anytime in life. Operating on the assumption that she is Type I. In that case, she is likely taking 2 types of insulin. Slow acting, like Levemir or Lantus. This works from 12-24 hours and is called a basal dose. It keeps the sugar down overall. Then, there is likely her fast acting insulin like Novalog. It is taken before meals to bolus or cover the carbs she eats. So, in order to meet the balance, the blood sugar MUST be taken in the A.M., before meals, at snacks and bedtime. I'd question what kind of dose they are giving her at bedtime, as it may be too large or at the wrong time.

A good endocrinologist would figure this out pretty quickly. I'd try to find one pronto. But, keep in mind that the person who is providing injections has to know how to carb count and the food that is expected to eat, must be eaten or you could go too low.  She likely needs to have the insulin formula recalculated to prevent these lows.   Normally, like with young children, I have read that the key is for the patient to eat the same thing every day at the same time. It's no fun, but, it lends itself to keeping the numbers within a good range.

If there is any chance that your mom is actually a Type II. I'd explore if pills only would work. A good endo would be able to make this determination.
Helpful Answer (1)
Report

@Sunnygirl1 No she is a Type 1 since she was about 16 years old. She is on two types of insulin. Her long lasting is toujeo solostar insulin https://www.toujeo.com/about-toujeo. Which is taken once a day. AT her next appoint on Thursday we are discussing taking her off this and moving her back to Levemir.
Her short acting is humalog sliding scale. They actually stopped giving it to her at bedtime in hopes that she would stop have the morning lows.
Hoping the the change in long acting will help this situation.
Helpful Answer (2)
Report

Got it. Levemir is what I take. Many take it twice a day ..once in the a.m. and once at bedtime. That way, you have more control. Some people need greater help during the day than overnight. With that adjustment and maybe, reevaluating her sliding scale formula, they can get it right. I hope it works well for her.
Helpful Answer (2)
Report

Just FYI just got home from checking my mom's sugar. She was 215 and then I got her to eat a chicken tender and small fries from Arby's, a banana and half a Glucerna shake.

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.
Helpful Answer (0)
Report

She was 215 and then she ate about 60 grams of carbs? Did she have a humalog shot before eating? Do let us know how the morning finger prick goes. Sure hope eating something helps!
Helpful Answer (1)
Report

From my experience, residents with dementia responds to colors. Make her plate colorful and food that are easy to digest so it will be easier for her to eat. Sometimes warm soups are good because you can add all the necessary vegetables.

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.
Helpful Answer (0)
Report

have an endocrinologist put a freestyle Libre continuous glucose sensor on your mom. It will record blood glucose every 15 minutes for 2 weeks. The doctor can download the data and make insulin adjustments based on the patterns seen. A sensor is only $60 and requires no meter calibration.
Helpful Answer (1)
Report

Tattoochick, how was Mom's glucose level this morning?
Helpful Answer (1)
Report

tattou -to keep her bs up at night she needs to eat protein for her bedtime snack. It works better than complex carbs. Chicken in any form would be good.
Helpful Answer (1)
Report

Humalog/Novolog is fast acting and it is imperative she eats if she is taking this. Who does her BS and provides the Humalog coverage? Surely she does not?
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. 
Helpful Answer (0)
Report

I think the Continuous Glucose Monitor is a good idea, however, when someone has dementia, they may not tolerate it well, pull it out, hide it, etc. They may not be able to understand why it's there and if they do, they may forget. It's a challenge to even keep dentures and eye glasses on dementia patients. Plus, when it alerts, the staff need to be aware and know how to respond. Based on what she says, I'm not sure they are trained in how to handle her condition.
Helpful Answer (1)
Report

So mom's reading the last three mornings
6/20 -53
6/21 - 203 (morning after night visit)
6/22 - 179

So hopefully finally things are going better.
Helpful Answer (0)
Report

The newest basal insulin is Tresiba. It is made by Novo Nordisk; the same company who makes Levemir. It has been shown to significantly reduce hypoglycemia compared to other basal insulins. Excellent choice if your insurance covers it. Also remember the goal for your mom is to prevent hypoglycemia. She does not need an A1c of 7. For her age and dementia, maybe an 8.5% and not having DKA
Helpful Answer (2)
Report

The never ending tale ... this morning we are at the ER as it looks like mom might have an infection of some kind, white cell count is elevated. Is it selfish to want a break from this. June has been not stop health issues.
Helpful Answer (1)
Report

Tattoochick,
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.
Helpful Answer (1)
Report

((((((hugs)))) - not selfish at all. You need a break. Hope it is nothing serious and gets treated easily and all settles down. It could affect her bs too,
Helpful Answer (1)
Report

Heck no! You've been dealing with those BS 3-4x/Day & what, 3 ER visits? I thought she may have an underlying infection messing up her blood sugar.
Hope it works out, TC, try to get some rest til tomorrow.
Helpful Answer (1)
Report

My FIL does not qualify for assisted living because he has his blood sugar level tested four times a day. The insulin based on that reading. AL do not provide skilled nursing so he's in a NH and hates it.
Helpful Answer (3)
Report

@Sorrynotsorry It took me and the help of three other people to find this ALF w/memory care that would take her with the siding scale insulin. They actually hire an outside home health company to come in and take care of all the ALF patients that need injects and certain medications (they have in house med techs, a nurse RN for the memory care floor from 7 am to 6 pm.) Home health checks her 3 times a day (two covered by the monthly "rent" and one I pay extra for. It is well worth it to keep her out of a NH. There are some seriously nice NH in the area, but it still feels like a hospital and my mom hated it also. Really trying to keep her at ALF for as long as possible.
Helpful Answer (0)
Report

Yes, this morning says her blood culture definitely so an affection / virus. After three weeks of this crazy back and forth, hoping all gets better. Since she has been admitted and getting antibiotics her sugar has been between 100 and 189. Yeah! Fingers crossed.
Helpful Answer (0)
Report

1 2 3
This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter