Type 1 life in care homes.

M

mjr@T1

New Member
Relationship to Diabetes
Type 1
Good afternoon all I am a very long term diabetic with a stupid number of family also all type 1. I've lived this life and been through all the changes in regime from set carbs and insulin to variable insulin and using a cgm.
Recently my dad moved into a care home and they have said they can only give an exact number of units specific to paperwork. This is 24 units of nova rapid 3 times a day regardless of foods eaten and no insulin given if no/small amount of food is eaten. This comes with not being allowed to give any insulin to correct highs so when his blood test was 24 they were not able to correct at all.
Is this something other people recognise too because it concerns me that there is no variable ability like there is when doing your own control.
I am trying to get things updated so there is the ability to give some insulin to correct but it just seems very old fashioned and completely the wrong way to do things especially as he has been doing it for himself for over 50 years and could easily give permission to make adjustments as needed.
Thanks
 
Is he in nursing care or residential care?

I only have experience of my mum with type 2 and on basal insulin. When she was in residential the district nurse had to come in and do it. She’s just moved to nursing care in the same home and now the nurse can do it.

I would have a chat with his GP as the home can only do what is on their instructions. It’s very hard to manage variable conditions in a care home setting in my experience but for his safety there needs to be a more responsive plan in place.
 
Thebearcametoo said:
Is he in nursing care or residential care?

I only have experience of my mum with type 2 and on basal insulin. When she was in residential the district nurse had to come in and do it. She’s just moved to nursing care in the same home and now the nurse can do it.

I would have a chat with his GP as the home can only do what is on their instructions. It’s very hard to manage variable conditions in a care home setting in my experience but for his safety there needs to be a more responsive plan in place.
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Hi it's a nursing home. From what I understand they have only the ability to do what is on the prescription and not make adjustments at all. It sounds like if they wanted to do anything at all they would have to have a paramedic come via a call to 999. It seems very convoluted when he has capacity to say I need 4 more units or 3 less because I've eaten less rather than going high low high low and never being steady at all especially having done it for himself and having a hba1c in the mid 40s for years and now it's it's generally in the high teens or twenties. I hope to get to speak to the specialist outreach team to ask them to allow him to give permission as and when it's needed or given a specific rule of if 15+ Give 3 units of 20+ give 5 units.
I think being a type 1 myself makes it harder because I know how to fix it for him but can't get it done yet.
I will say that the prescription will say as with mine use as directed which for me means variable usage depending on food intake and exercise illness and all the other many things that send glucose levels all over the place.
 
I know it’s difficult when you know what should be done. My mum was running high for months but the GP seemed happy with the basal dose. I think it unlikely that they will allow him to manage his own meds because of liability issues and likewise for variable doses. It should be fine to give him juice or something if he’s not finishing his meals to avoid hypos and the GP or diabetes team may adjust the fixed dose once they see that he’s constantly high. It’s very difficult and I understand your frustration. With schools there is more flexibility than with care homes.
 
Hmm having been diabetic from the age of 5 I've done plenty of life now in my 40s things are strangely both easier but hard due to the fact I've been diabetic for so long nothing is easy to get. Does seem newbies can get all the new toys. It feels for dad they are back to my childhood of set insulin at set times and set carbs amounts. Unfortunately he also is highly resistant to insulin now after 54 years he's on 60 units of lantus nightly and I might have expected that to increase if it wasn't so much already. I feel he would be better on a sliding scale/constant infusion instead to keep it ticking over like in hospital.
I will update once I've managed to speak with the GP
 
I asked my D clinic once - years ago by now but after I'd happily been pumping for some years - how many people in care homes were using pumps - and they weren't aware of any - but there again why/how would they know? I was horrified when I smashed my kneecap and because they had to operate to do the jigsaw decided to put me on a sliding scale and would be giving me 3u per hour. At the time my TDD basal was 10.58u and about 10 -12u ish TDD bolus, so less than 25u entire TDD. Admittedly I did, after I came off the scale, need to increase the basal to 300% and couldn't start reducing that until after I got out of there when I could test test test and gradually sort it, I had nowt else to do except lie on the settee all day as my leg was immobilised and took a good couple of months to get it back down to where it was again. Phew! A very narrow escape from dying under anaesthetic! - but only because I argued - loudly! - with the staff! I do get loud quite quickly these days when people are clearly not understanding me, whether they're medics or family.
 
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