Mum in nursing home has nutrition problems

[SisterAnna]

Hello all
I wonder if anyone could offer me advice about my mother, who is 87 and in a nursing home. She has dementia and has had type 2 diabetes for about 20 yrs. She is tiny and considered underweight so has been given 'nutritional support' in the form of a sachet of powder which is added to her food (pureed due to swallowing difficulties. On insulin injections as she can no longer swallow tablets) But since she has had the supplement her blood sugar has skyrocketed, and all the staff think to do about it is cut down her food! It seems bonkers to give her supplements to build her up but then reduce her food as her blood sugar is high! The nurse ticked me off for giving Mum a banana, (which she loves). She tested her blood sugar less than 10 minutes after Mum had eaten it and basically blamed me for it being high. Surely it takes more than 10 minutes for food to affect blood sugar? Poor Mum, one of her few remaining pleasures in life is eating, she loves her food. I feel she should be able to eat what she wants, as long as she can swallow it, and her blood sugar should be managed by medication, while she's on this supplement. It's heartbreaking when she constantly tells me she's hungry and I'm not allowed to do anything about it. And she weighs less than six stone dripping wet! Any help gratefully received.

 

[Northerner]

Hi SisterAnna, welcome to the forum 🙂 What insulin therapy is your mother on? Do you know what is in the supplement your mother is being given, particularly the carb content? Have you tried testing your mum's levels prior to her eating the banana so that you know what the relative rise is? Unless the banana was very ripe - i.e. almost black! - I would doubt that it would hit her levels as quickly as ten minutes. I suspect that the staff do not understand diabetes very well

I would agree that she should be able to eat as she pleases, if her insulin can be adjusted to take into account the amount of carbs in her food. She really shouldn't be having to go hungry, bless her!

 

[margie]

Hello SisterAnna and welcome to the forum.

Its so hard seeing your Mum suffer, I guess she is a ward that specialises in Dementia - in which case the nurses may have only basic knowledge of diabetes. Do you know if there is a DSN (Diabetes Specialist Nurse) who is looking after her - or who you could request sees her - if she is in a large hospital there are likely to be one on staff - but community DSNs exist too.

Do you know what insulin regime is on, some type 2s are just put on a background insulin at first to see how they go - this will not cover food. Othe possibilities are mixed insulins twice a day, and MDI which consists of a background insulin plus fast acting insulin injected with meals.

The other thing is that pureed food hits the blood stream a lot faster than non pureed food. The pureeing means that the sugars in the food (glucose, sucrose, fructose, starch etc) will hit the blood stream faster so that is probably adding to the situation.

If you can let us know what regime she is on then hopefully we can give a more tailored response to you.

 

[ukjohn]

Sister Anna.

I have shown this message to my daughter who is a Senior Carer in an Nursing Home. Her advice is for you to contact your mums Social worker explain to her what you say here and tell her you want a review of her care plan at the nursing home. She says that it is abuse to cut back your mums food if she is hungry, there are other supplements such as Ensure savoury soups, she should be provided with food without it being reduced, and if her sugars are running high, the on duty nurse should ring the doctor for permission to increase her insulin, the reason for ringing doctor is, that the nursing home are not allowed to increase any medication under prescription without the doctors ok. Hope this go's a little way to helping, please feel free to PM me if required we can arrange phone chat with my daughter if you want.

John

 

[Ellie Jones]

I've asked my husband about this as he's a residential care supervisor.

He said you need to speak to the manager

Check her care plan, if your has mum dementia then a family member should checking care plan on a monthly bases and signing it..

Ask the manager if any of the nurses have any nursing qualifications in diabetes..

Also check that she's having diabetic checks from her surgery gp and diabetic nurse.. If she's not make a request for this to happen if the nursing home won't do it you can contact her GP yourself to make the request..

I would also ask for a meeting with doc, a diabetic nurse etc to discuss her diabetic care..


Next time a nurse says anything about you giving your mum food, ask her if she's qualified diabetic nurse.. And you can remind her that she is over stepping mark she has no right to prevent from this, she advise it's wise

Oh, he said that if find yourself in the situation that 10 minutes after she's eaten that a nurse takes a bg, infers that a high reading is down to you, as her what does she expect..

If you still feel that the nursing home isn't acting in your mum's best interest or are totally ignoring you, then get hold of the Care Quality Commission (care standards www.cqc.org.uk there website will give you the local number, also on this site you can find the inspection reports for your mum's nursing home as well..

And yes the CQC will looking into every complaint they receive however small they might seem.

 

[SisterAnna]

Hello Northerner and Margie
Thank you so much for your speedy replies! I'm afraid I don't know what her exact insulin regime is, she was on gliclazide for many years and was only switched to insulin injections when she could no longer swallow the tablets. However, I am meeting the head of care at the nursing home tomorrow and will ask her for chapter and verse. The supplement she is being given is called pro-cal and according to the company website, is a mixture of proteins, carbohydrates and fats, the total carb content is given as 28 grams per 100 grams of product, of which 16 grams is sugars ! She obviously isn't given 100 grams at a time - that would be over three teaspoons -- but in percentage terms it still seems to me that a 16 pct sugar content is quite high! Meanwhile, I will come back again tomorrow with as much info about the insulin as I can glean. Thanks again.

 

[SisterAnna]

And many thanks too to Ellie Jones and UKJohn -- you have all been incredibly helpful and have given me lots of points to bring up in my meeting tomorrow. I am now going to make some careful notes to take with me to the meeting, incorporating your suggestions. I will also keep it in mind about taking it further, if need be. I will let you know what transpires! Best wishes to all.

 

[trophywench]

It's ALL carbohydrate that increases blood sugar - not just sugar itself. So it's the total carb value that matters. When you are on insulin - sugar is just another carb to be accounted for/negated by the insulin dose given.

Hunger is also a sympton of high blood sugar .... the basis for that being if you haven't got anough insulin in your body (naturally or injected) to deal with the glucose in your blood, the cells can't get at the glucose (insulin is the key that opens the cell doors to let the glucose in) and hence are literally starving - hence they indicate to you that you are hungry .....

 

[margie]

Good Luck SisterAnna with tomorrow's meeting.

 

[spiritfree]

Good luck with your meeting tomorrow. I find meetings a little easier if I make a list of items which I need to discuss. This way you don't remember something that you wanted to ask, when you are halfway home.

 

[Copepod]

Hope it's not too late to add a suggestion.

Great to hear you will meet the nursing home staff and get some information about your Mum's insulin regime etc. As she has such complex nutrition needs (diabetes, low body weight, needing building up, swallwoing problems, dementia) she really needs and deservee some proper input from a specialist dietician. Community dieticians are in short supply in many areas, so thre may be a long delay before she can see one, but definitely worth speaking to GP as soon as possible to start the referral process.

 

[SisterAnna]

mum in nursing home has nutrition problems-update

Hello all and thanks again for your help yesterday, for those who asked about Mum's insulin regime, the details are as follows - she has an injection of eight units of insuman basal solostar once a day. She is given three units of actrapid as necessary when her blood sugar levels are high. The meeting today was not really conclusive, but I have the name and number of the specialist diabetic nurse and I am going to phone her tomorrow.
The nursing home's main concern seems to be along the lines of 'CYA' (if you know what I mean). They are in the firing line if anything awful were to happen so I do understand that, to some extent, but I reiterated that my concern was for my Mum as a whole person, in particular her happiness and emotional well-being, not just her medical condition. So - stalemated for now, but I will keep on pursuing it. Thanks to all and will keep you posted about any developments.

 

[margie]

It sounds like the DSN and the nursing home staff need to talk more. If your Mum's sugar levels are consistently high they need to change the dosages.

Diabetes can be quite slippery - and people can end up in trouble with too little medication, and equally in trouble with too much (though this might be more dramatic). Perhaps bring that up with them in the next time you meet.

Good Luck with the nurse tomorrow.

 

[Ellie Jones]

Well your mum's present regime I don't really call acting in the 'CYA' mode of practice...

Words like 'High' and 3 units are very contestable indeed... I do this as an example, if 1 unit of insulin dropped BG by 3mmol/l then 3 units would dropped it by 9mmol/l no problems if BG is 18mmol/l but if 10mmol/l she's going to have problems..

If they want the play the 'CYA' game they need to note down what is consitutes as 'high' with a follow-up sliding scale so that insulin can be probably adjusted to suit the 'high' reading.

I can understand the need in your mum's case to work on a reactive regime rather than a pro-active regime as in basal/bolus... As the dangers of injecting insulin pre-meal to a carb count. As it would be very difficult and an higher risk of over shooting, when trying to determine how many carbs you mum's is going to manage to eat.

I would ask the next time you are in to see mum, to see her MAR sheet and her BG readings. Any insulin/medication will be entered on the MAR sheet, her BG's might be entered her but more likely in her care plan, it really depends what record system they use, but it will be written down, if it isn't then one as to assume that they have been doing BG testing etc...

I would go ahead and ring her diabetic nurse get her involved and ensure that when she see's your mum that you are also present so you know what's going on.

Any rubbish thrown your way, don't be afraid of complaining to the Care Quality Commission, if you inform the manager that this is what you are going to do, it normally puts the fear of god into them and gets things moving...

More so now things have changed, now if a establishment is failing then the CQC can prevent new admissions being admitted until problems with the home have been rectified before it was a one step shut the home completely down and move all residents elsewhere... Which rarely happened even when major problems existed because in general due to the lack of available accommodation elsewhere, which badly managed homes knew so never had the incentive, but now with not being allowed to admit new residents until they comply really hits them hard...