Uncontrolled Diabetes So Being Sent To Nursing Home

[BA66]

Hi, I am posting on behalf of my brother who is type 1 diabetic & currently in hospital with uncontrolled diabetes. The hospital, after 2 months, haven't been able to stabilise his blood sugar (no diabetic menu, no meal monitoring, little interaction with diabetic consultant) and he has had hypos at night and daytime levels reaching to high 30s. There is a discharge meeting thursday and the recommendation will be for a nursing home. My brother is a very fit 64 year old and I would like to know if people with similar challenges have been able to live on their own with district nurses (and family support) without being shut up in an institution .
I am not sure we will have any say on the matter, but I would like him to be in a greater care housing complex/sheltered housing with medical input and quality of life...
Thanks for any input. I need info pls.

 

[Freema]

it is so hard to give advice in such an acute situation, why is his diabetes uncontrolled ? is he new to having the condition, or has it suddenly gone out of control, when you say fit do you then mean slim or do you mean active and sporty? most type 1 in here seem to be able to control their diabetes and insulin injections and some are really good at giving advice .... does your brother have other diseases or infections which in many cases can affect his diabetes/blood sugar levels a lot ...

it sounds like the hospital is not very good at treating diabetics, but then we only have your words for it, a lot of other stuff could be going on in your brother's body making it difficult to find the right way to attack the blood sugar fluctuations

 

[Juicyj]

Hello @BA66 Sorry to hear about this situation with your brother.

My concern with any nursing home is what provision would be made in their care to accommodate your brother, and how many staff have had training to help with insulin administration and general well being. So first thing would be to speak to the nursing home manager to ask this question.

Diabetes UK has some information for older people and care homes: https://www.diabetes.org.uk/Profess...-care-for-older-people-resident-in-care-homes

Hope this helps.

 

[Resurgam]

Having worked in a nursing home I could not say that it would be the best environment for a diabetic as there was a routine which had to be stuck to, and the 'inmates' were secondary to that necessity. I was only there for a few hours in the day, working in the laundry, and it was some time ago, but it was considered 'not safe' for cups of tea to be available because a member of staff was not available to supervise the drinking of it, so they were only available at meal times.
My reading of this forum makes me suspect that the insulin regime your brother is on is wrong - so there is not enough insulin of the right sorts to cover daytime, but too much at night. Being of a logical mind my questions would be just how much of which insulin is being given and when - also the timing of meals, carb counting and bolus units to carbs ratios, which can alter throughout the day.
Having read the explanations given on the forum of all the techniques type ones have used and refined for themselves, I might very well be overly confident in my understanding of the problems and solutions for a condition I do not have, but the regime of a nursing home does seem to be exactly the opposite of what your brother, or any type one might require.

 

[Fairygodmother]

Hi @BA66, what insulin have the hospital put your brother on? Has he any other health issues, despite being ‘very fit’? Are you in the U.K.?
Most people with Type 1 in the U.K. look after themselves with support from a GP, a Diabetes Specialist Nurse and a Consultant who they see approximately once a year. Most will be able to participate in a Dafne course (it has different names in different parts of the country) which gives the skills required to match insulin doses to carbohydrate eaten.
How long has your brother had T1? Has he always had problems keeping his blood glucose under control?
It seems that either the hospital has been inefficient in applying medical knowledge to your brother’s health problems or there are some other underlying issues. Without more information it’s difficult for us to comment: we can’t tell you what to do, we can only offer suggestions or tell you things that we’ve discovered for ourselves as a result of living with the condition.
Your brother’s young to be in sheltered housing, so I’m assuming that he may not find it easy to look after himself if that’s what you’re wishing for him. Is this so?

 

[JMK1954]

It sounds to me as if a change of consultant or hospital is required.
When was your brother diagnosed with type 1 ?
What have the hospital done to improve his control ? Have they tried different insulins ? As Fairgodmother has said, we don't know what the situation is, so that makes it difficult to offer advice. Sorry for the barrage of questions.

 

[Alison54321]

Is this in the UK? this is a ridiculous situation. He should be being offered technology, like a pump, or cgm,to help him control his blood sugar.

As long as he is mentally capable of managing his diabetes, and as long he is reasonably fit it shouldn't be a problem.

Sadly, there are some areas where health services are not particularly good.

Contacting Diabetes UK would be a good start, if you're in the UK. He clearly needs proper representation, and an advocate, who knows what they are talking about.

 

[DCUKMod]

Hi, I am posting on behalf of my brother who is type 1 diabetic & currently in hospital with uncontrolled diabetes. The hospital, after 2 months, haven't been able to stabilise his blood sugar (no diabetic menu, no meal monitoring, little interaction with diabetic consultant) and he has had hypos at night and daytime levels reaching to high 30s. There is a discharge meeting thursday and the recommendation will be for a nursing home. My brother is a very fit 64 year old and I would like to know if people with similar challenges have been able to live on their own with district nurses (and family support) without being shut up in an institution .
I am not sure we will have any say on the matter, but I would like him to be in a greater care housing complex/sheltered housing with medical input and quality of life...
Thanks for any input. I need info pls.

BAA - Was your brother admitted to hospital because of his uncontrolled diabetes, or was his diabetes uncontrolled, as well as having another health issue, requiring the admission?

I ask because, as I'm sure you may be aware, so many other factors like infection, pain, use of certain medications, like steroids for other "stuff" and stress, to name just a few things can really cause the blood sugars to go a bit wonky to say the least. I guess I'm trying to work out if there's a chicken before the uncontrolled blood sugars egg.

 

[novorapidboi26]

No reason why he shouldn't be able to manage on his own with the tools and knowledge available today....

I agree with what has been said so far......lots of questions to answer....

 

[bulkbiker]

I'm guessing there is quite a lot of this story we are not privy to and as the OP has never bothered to reply....

The chances of a 64 year being admitted to a nursing home I would hope are pretty slim unless there are other factors in play. Especially as I'm only 7 1/2 years away from that age myself...

 

[DCUKMod]

@BA66 - Mulling this over a bit more, is your brother being transferred somewhere to convalesce from his current predicament?

My (non-diabetic, normally in good health) neighbour, when she had her first hip replcaement in her mid-60's (I think), had a really rough time with the anaesthetics and wasn't able to recover as quickly as expected, so he wa actually transferred to our local cottage hospital with is really for those unable to cope at home any more, with a few rooms for convalescence. It could be somethng like that?

Otherwise, I'm with the others in astonishment that your brother would be being sent to a long term nursing home, rather than some form of sheltered or supported care, in his own home or in a sheltered housing community.

All very puzzling.

 

[KK123]

Hi, I am posting on behalf of my brother who is type 1 diabetic & currently in hospital with uncontrolled diabetes. The hospital, after 2 months, haven't been able to stabilise his blood sugar (no diabetic menu, no meal monitoring, little interaction with diabetic consultant) and he has had hypos at night and daytime levels reaching to high 30s. There is a discharge meeting thursday and the recommendation will be for a nursing home. My brother is a very fit 64 year old and I would like to know if people with similar challenges have been able to live on their own with district nurses (and family support) without being shut up in an institution .
I am not sure we will have any say on the matter, but I would like him to be in a greater care housing complex/sheltered housing with medical input and quality of life...
Thanks for any input. I need info pls.

BA66,

Obviously we can only go on the content of your post which says your brother is a very (mentally as well?) fit person whose only issue is out of control diabetes. If this is the case DO NOT be bullied into going along with what the Social services/hospital say. It is the choice of your BROTHER and the only way they can force it upon him is if they are saying he is mentally unfit to decide for himself. You as his family also has to be listened to. There are other options before a nursing home, I cannot believe they are suggesting this and you can rest assured it will be because it is easier for THEM to monitor your brother in a home with 24/7 nurses rather than visit him every day under the district nurses.

Don't get me wrong, if your brother is regularly falling on the floor, going unconscious at all times and clearly a danger whilst living on his own then you wouldn't want that to continue if he lives on his own. There are so many factors that come into this so it is hard to advise.

My Mum was in the exact same position albeit older and after she could no longer live alone she went into accommodation with a warden, then a few years later sheltered accommodation, one with a 24/7 team (but not a nurse), and eventually a nursing home. Please read up on your brother's rights with regard to this issue, my Mum had district nurses coming in 3 times a day in the sheltered accommodation which we had to fight for.

The social services will always suggest what is easier for them, I genuinely think they do care but they are restricted because of the NHS finances etc so you can guarantee they will take the easiest route. Does your brother normally live alone?, please tell us more about his daily life and how exactly does his diabetes manifest itself.

Good luck x

 

[BA66]

Hi @BA66, what insulin have the hospital put your brother on? Has he any other health issues, despite being ‘very fit’? Are you in the U.K.?
Most people with Type 1 in the U.K. look after themselves with support from a GP, a Diabetes Specialist Nurse and a Consultant who they see approximately once a year. Most will be able to participate in a Dafne course (it has different names in different parts of the country) which gives the skills required to match insulin doses to carbohydrate eaten.
How long has your brother had T1? Has he always had problems keeping his blood glucose under control?
It seems that either the hospital has been inefficient in applying medical knowledge to your brother’s health problems or there are some other underlying issues. Without more information it’s difficult for us to comment: we can’t tell you what to do, we can only offer suggestions or tell you things that we’ve discovered for ourselves as a result of living with the condition.
Your brother’s young to be in sheltered housing, so I’m assuming that he may not find it easy to look after himself if that’s what you’re wishing for him. Is this so?

Hi thank you for your reply. Sorry not to be clear, was feeling bit deperate yesterday, things look less bleak today. I appreciate ppl can't comment on an individual's situation and I didn't give full info or the post would have been v long! Was mainly wanting to find how ppl coped with problematic blood sugars in a community, rather an institution setting.
Chris has had t1 I think about 10 years. I live in UK but other side of country and don't drive so been in contact by fone. We found a letter from gp saying his sugar levels were too high from 3 years ago. I'm afraid he doesnt take his health very seriously and not very educated on dietary stuff. He was admitted for very high blood sugar and mental confusion 2 months ago and the hospital aren't unable to regulate it. It was 22 before breakfast this a.m. My sister and I are wondering if he has brittle diabetes and are trying to get him seen by diabetic consultant whom he has had scant contact with being put on general medical ward. He has had tests and is clear for dementia though I think that will ve the fallback diagnosis as they don't know what's causing the muddledness, though a Dr did say the persistent high-low swings could be causing his confusion (he's generally fine but dodgy in some areas)
Thank you for your input.

 

[BA66]

@BA66 - Mulling this over a bit more, is your brother being transferred somewhere to convalesce from his current predicament?

My (non-diabetic, normally in good health) neighbour, when she had her first hip replcaement in her mid-60's (I think), had a really rough time with the anaesthetics and wasn't able to recover as quickly as expected, so he wa actually transferred to our local cottage hospital with is really for those unable to cope at home any more, with a few rooms for convalescence. It could be somethng like that?

Otherwise, I'm with the others in astonishment that your brother would be being sent to a long term nursing home, rather than some form of sheltered or supported care, in his own home or in a sheltered housing community.

All very puzzling.

Thankyou for your reply.there don't seem to be convalescence homes any more so we are treating the nursing home
As an interim option until we get sheltered housing. There is a place near me that has very good facilities and he would still have independence with district nurses coming in. I am hopi g he can get better care in nursing g home rather than the hospital (east surrey) who, in this case, don't seem to treat diabetics with much specialused care.

 

[BA66]

BA66,

Obviously we can only go on the content of your post which says your brother is a very (mentally as well?) fit person whose only issue is out of control diabetes. If this is the case DO NOT be bullied into going along with what the Social services/hospital say. It is the choice of your BROTHER and the only way they can force it upon him is if they are saying he is mentally unfit to decide for himself. You as his family also has to be listened to. There are other options before a nursing home, I cannot believe they are suggesting this and you can rest assured it will be because it is easier for THEM to monitor your brother in a home with 24/7 nurses rather than visit him every day under the district nurses.

Don't get me wrong, if your brother is regularly falling on the floor, going unconscious at all times and clearly a danger whilst living on his own then you wouldn't want that to continue if he lives on his own. There are so many factors that come into this so it is hard to advise.

My Mum was in the exact same position albeit older and after she could no longer live alone she went into accommodation with a warden, then a few years later sheltered accommodation, one with a 24/7 team (but not a nurse), and eventually a nursing home. Please read up on your brother's rights with regard to this issue, my Mum had district nurses coming in 3 times a day in the sheltered accommodation which we had to fight for.

The social services will always suggest what is easier for them, I genuinely think they do care but they are restricted because of the NHS finances etc so you can guarantee they will take the easiest route. Does your brother normally live alone?, please tell us more about his daily life and how exactly does his diabetes manifest itself.

Good luck x

 

[BA66]

Thank you for your reply. I didn't put everything in post as I needed some general input about options for living independently. Unfortunately he has some mental confusion alongside the blood sugar swings. It seems he has had uncontrolled diabetes for possibly 3 years so my feeling is that this has affected brain chemistry, the doctor agreed that long term hypos and hypers would be detrimental but there is no data for this. Easier to put him down as a dementia diabetic patient. He had 3 tests for dementia and passed all of them but he needs to go in a box.
My brother normally lives alone. I can't give day to day info on his diabetes am afraid as live out of his area and he never spoke about his health. We are trying to get diabetic consultant on the case for now and treat nursing home as convalescence til we can find a nice flat somewhere suitable with family contact.
Thanks a lot.

 

[Alison54321]

Good to hear you are starting to get things sorted.

High stress levels can cause mental confusion, can cause high blood sugars, and create a sort of vicious circle. Managing diabetes, especially when you aren't doing it very well, can be very stressful.

So if you can manage to get specialist diabetes doctors on the case, and they can help with better control, things may well start to improve.

 

[MrsGruffy]

He really needs to get his BG under control. When mine were up at his level, I couldn't think straight. I had to give up on my uni studies because I simply couldn't retain information. Be sure to ask them to check for a UTI too, as they are common when the BG is going really high. He may also have delirium, which is a temporary condition, more common in older adults admitted to hospital, and easily confused with dementia. All the best to you and your brother.

 

[BA66]

BAA - Was your brother admitted to hospital because of his uncontrolled diabetes, or was his diabetes uncontrolled, as well as having another health issue, requiring the admission?

I ask because, as I'm sure you may be aware, so many other factors like infection, pain, use of certain medications, like steroids for other "stuff" and stress, to name just a few things can really cause the blood sugars to go a bit wonky to say the least. I guess I'm trying to work out if there's a chicken before the uncontrolled blood sugars egg.

Thank you for your reply. He was admitted with blood sugar highs and confusion, which has reduced a bit, he has had 3 different tests for dementia but he shows no signs, although that will ve the gall back diagnosis sadly. ... We are fighting him to get more help with BG stabilisation. Unfortunately it seems he may have had uncontrolled diabetes for a few years, something we need to get him to address as well as get good medical input. This forum has been very useful as my sister and I are very ignorant of whats available and difficult to put options forward about management at home rather than a nursing home. He is a self funder so perhaps it's easier too....
Many thanks.

BA66,

Obviously we can only go on the content of your post which says your brother is a very (mentally as well?) fit person whose only issue is out of control diabetes. If this is the case DO NOT be bullied into going along with what the Social services/hospital say. It is the choice of your BROTHER and the only way they can force it upon him is if they are saying he is mentally unfit to decide for himself. You as his family also has to be listened to. There are other options before a nursing home, I cannot believe they are suggesting this and you can rest assured it will be because it is easier for THEM to monitor your brother in a home with 24/7 nurses rather than visit him every day under the district nurses.

Don't get me wrong, if your brother is regularly falling on the floor, going unconscious at all times and clearly a danger whilst living on his own then you wouldn't want that to continue if he lives on his own. There are so many factors that come into this so it is hard to advise.

My Mum was in the exact same position albeit older and after she could no longer live alone she went into accommodation with a warden, then a few years later sheltered accommodation, one with a 24/7 team (but not a nurse), and eventually a nursing home. Please read up on your brother's rights with regard to this issue, my Mum had district nurses coming in 3 times a day in the sheltered accommodation which we had to fight for.

The social services will always suggest what is easier for them, I genuinely think they do care but they are restricted because of the NHS finances etc so you can guarantee they will take the easiest route. Does your brother normally live alone?, please tell us more about his daily life and how exactly does his diabetes manifest itself.

Good luck x

It sounds to me as if a change of consultant or hospital is required.
When was your brother diagnosed with type 1 ?
What have the hospital done to improve his control ? Have they tried different insulins ? As Fairgodmother has said, we don't know what the situation is, so that makes it difficult to offer advice. Sorry for the barrage of questions.

 

[BA66]

Thank you for your reply. He was admitted with blood sugar highs and confusion, which has reduced a bit, he has had 3 different tests for dementia but he shows no signs, although that will ve the gall back diagnosis sadly. ... We are fighting him to get more help with BG stabilisation. Unfortunately it seems he may have had uncontrolled diabetes for a few years, something we need to get him to address as well as get good medical input. This forum has been very useful as my sister and I are very ignorant of whats available and difficult to put options forward about management at home rather than a nursing home. He is a self funder so perhaps it's easier too....
Many thanks.