[foodahollic]

Instead of eating and then Injecting Insulin.

I am a Type Two. I know a local Nursing home usually feeds their patients, usually a starchy, carby meal. Then the staff goes around and measure Blood Glucose, Administers a dose of Insulin. Not that I think that is the correct way to do it. But given the limited amount of staff, this is the way some places are forced to handle it.

I used to be homeless, and injecting just before a meal is a good way to be thrown out on the street before eating.

While my doctor is adamant to inject probable correct Insulin dose before a meal. and now, no correction dose. No second injection of short term insulin twice in three hours.

What do you guys hear from the Experts. Doctors? Diabetes Educators?

 

[itissteve]

I know how difficult it has been to staff institutional care facilities over the past several years. Most places are short staffed and their continued operation depends on staying open and occupied. The last thing they want/need is doubling up on workload. So even if the medical recommendation is/was one good guess and no more for three hours, the staffing issue looms large.

Giving a diabetic insulin before a meal and then checking later if the dose was correct (and possibly having to give another dose) is twice the work. If they dose after eating (ideally within a hour or so afterward), the BG probably has peaked (I've seen nursing home menus; they're refined carbohydrates on parade) and they can inject a somewhat appropriate counter of insulin and be done. Glove up fewer times, do fewer meter sticks, use less insulin and syringes, do less paperwork. Among a client population that is there for a median stay of 9 months to two years, tight BG control may not add significantly to the patient's longevity or quality of life.

I'm sorry if that sounds impersonal or inhumane, but the labor part of institutional care is one of the toughest problems there is right now. A lot of good patient care is being sacrificed to what people (including Medicare/Medicaid as a proxy) are willing to pay staff. And staff are opting out of the field.

I am interested, though, to hear other views from doctors, regulatory agencies, etc.

 

[mbuster]

I think the bad thing with injecting before eating, as you alluded to, is something happening and not eating right then. But for a person taking care of themself who knows their insulin to carb ratio and correction factor, BG would certainly be smoother injecting before a meal instead of waiting to see how high it goes and then injecting for that. But even then knowing how much to inject to keep it ballpark would definitely be helpful.

But in a nursing home care facility so much can happen to not eat or eat all the food intended, after the fact injection may be the safer way to go, amply staffed or not. The low in the premeal injection and not eating scenario could potentially be worse than the high from the post meal injection.

As long as I could take care of myself, I would do the premeal.

 

[itissteve]

As long as I could take care of myself, I would do the premeal.

I'm with you. I wonder, though, how many patients at a nursing home/LTC facility can do it themselves -- and how many might do it except for the facility's insurer, who sees possible events and lawsuits because Mabel or Horace thought they gave themselves enough insulin but they didn't read the meter right or didn't dose it accurately or didn't inject it all. That's the kind of bureaucracy which decrees that nobody self-administers.

 

[etherea]

And nursing home patients have the right to refuse medication--my diabetic mother wasn't on insulin, but Metformin and many other medications for various ailments. She was only a mile from me and some nurses would call me to come and encourage her to take her meds. She was known to bite when she was agitated and it didn't matter if it was a worker or me. She had all her own teeth!

 

[itissteve]

And nursing home patients have the right to refuse medication

Very true. We experienced that with a friend of ours in the later stages of dementia. One day he'd be just fine; the next day he'd hide the pill or flat out refuse to take it. Sometimes his wife couldn't even persuade him.