How frequently should Dad's blood sugar be tested?
My father-in-law is 90, has type 2 diabetes and resides in a nursing home that only tests his blood sugar three times a week, but gives him insulin daily. We have had issues with this. His in-house doctor says that this is her protocol and isn't willing to change it. Is this normal? What can we do?
Expert Answer
Research suggests at least 25 percent of nursing home residents have diabetes in the United States. Currently, clinical practice guidelines for this vulnerable population do not exist. The issue faced by your father-in-law and the shear numbers of people with diabetes in nursing homes is an example of why we need national guidelines tailored to the unique care environment.
Checking daily glucose is obviously a critical step in optimizing diabetes care, especially since he takes insulin and is statistically at higher risk for hospitalization due to low blood sugar (low glucose or hypoglycemia). Nursing homes often have diabetes care protocols, but they vary by institution. Further, physician's orders for the frequency of glucose monitoring would trump any facility protocol.
Many long-term care residents have multiple medical problems with diabetes taking side stage. If hypoglycemia has not been an issue, and his 3-month glucose average (A1C blood test) has been close to 7%, the physician may think occasional monitoring will provide enough information and keep your father-in-law safe.
What can you do? Discuss your concerns again with the physician and ask why daily monitoring is out of the question. You may also speak to the director of nursing at the facility or contact your local Long-Term Care Ombudsman Resource Center (call 202-332-2275 or check www.ltcombudsman.org to find one in your area). Ombudsmen advocate for residents rights and quality care. And if not satisfied with the care provided, it is within his right to find someone else who is willing to step up his diabetes plan of care.