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help needed, T1 elderly lady

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bonnieheather

Newbie
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hi all,
i am in needed of some information for one of my service users, who is in her 90s.
i have noticed that over the past few weeks she has been having more hypos, she is injected every morning by the District Nurse, but from what we can gather they do not take her blood sugar levels ever and she is injected with the same amount every day. she has one injection in the morning, the long lasting one.

any help would be fantastic, as we are waiting to see the Diabetic nurses to have a chat, and i would like to be able to put some valid points across when we do.

many thanks

bonnieheather
 
Hi, would probably need to know what kind of long acting insulin? and what the lady eats? Also, how long has she been type 1 for? Hard to advise without BG info, I am hoping her DN's will have some info about her medical/diabetic background........
 
Hi,
Some points that come to mind . Really just questions you might want to think about or ask.
Is your client actually measuring her levels as hypo, or just feeling hypo? Sometimes people feel hypo at higher levels than are really hypos. What does she do when she feels hypo? Has she some way of getting help quickly? Do the hypos happen at the same time of day? (really these are questions concerning the ladies safety)

what type of insulin is being used? what about other medications? If she is geting hypos then this is because she may be being injected with too much insulin for her needs. Once daily insulin by it's nature isn't very flexible.

It seems incredible that her glucose levels aren't being checked at least once daily to titrate the dose see for example
http://www.diabetesuffolk.com/Insulin/How to adjust your dose of insulin.htm#_Toc127267598
Has anyone looked into her diet?. Is she eating regularly and how much is she actually eating?

What is the ladies HbA1c?
 
hi,
thanks for the replies.

the lady has dementia so all her meals are made for her, she has good healthy balance meals 3 times a day, and also a light snack mid morning and afternoon.
i am unable to answer the medical questions you have asked as the DNs deal with that, also, she doesn't inject herself, the DNs do that every morning. All i can be sure of is that its the long lasting insulin, and she doesn't have to eat as soon as poss after the injection.

thank you again for your help.

bonnieheather

oh, and we have been monitoring the hypos, she is unsure as to what is going on and doesn't remember them afterwards.
 
Does anybody actually observe this lady eating ? People with dementia often do not eat what is on the plate and may also hide the uneaten food.
 
oh yes she does eat her meals, all of them and every last bit!
thats why we are thinking that it may be how much she is being injected every morning? that and the fact that the blood sugars are never taken before, so how on earth do they know how much to give? is it common practice to give the same amount every day?
really confused.....
thanks again

bonnieheather
 
She really needs to be properly assessed and tested regularly. As you age your needs change, your body does not absorb so well etc.
 
thank you so much, thats what we were thinking :)
now we just have to convince the DNs and the Diabetes Nurse!
wish us luck lol
thanks again for all your help
bonnieheather
 
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