How can I get my diabetic mom with dementia to eat more?
My mom is living in an ALF Memoery Care Floor. She is a type 1 diabetic. Every morning when they check her sugar she is extremely low. We have been working with her doctor to adjust her insulin, however the really solution would be for her to eat more or any of her dinner and her evening snack (which they do bring her). I have given them lists of what she likes to eat, I have advice them to sit with her a few moments to chat. Do I really need to go there everyday at dinner to make this happen? Today I went there just a few moments after dinner started, she was the only one at her table without a plate. They said she did not want anything but drank a gluerna so she should be good. I said no, let's get her a plate and see what she will eat. She at the vegetables and fruit, drank a glass of milk and then an extra banana. She said no, but eat some just because it was in front of her. I total them to bring her a PB and Jelly and another banana for her snack. Lets see if I get a call in the morning. Any advice, as I am afraid the ALF will be asking her to move out. (She likes it there and as finally seems settled after a year and half of moving her from place to place.)
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If one had to choose, it would better to have high blood sugar than all these drops for her.
You can bring her glucometer in with you to the doctor visit as the machine keeps a history of prior BS for them to review.
I would make sure she had fast sugar even hard candy sources available at all times or glucose pills in her room.
It sounds to me she may need her insulin needs adjusted as she may be prescribed an amount from when she ate more but her intake now has changed.
Just a thought. My mom ate like a bird for the last couple years of her life. She wasn't diabetic though.
Please keep us posted.
The ALF is trying to get her to eat again at 8 pm but she is at her worst in the evening, stubborn and just does not care.
I feel like I am just wating everyday for the ALF to say she can not live there anymore. This would mean a Nursing Home for her. I don't have anything against NH. Over the past year and half mom has been in 3 different ones in the local area and each cared for her. However, she gave up in them. She would not get out of bed, worse eating problems, did not want to bath. Plus contently call me in the middle of the night to say I was keep her in jail and it was not right and just not nice things.
At her current ALF she does get up, she dose (except dinner and night snack) she baths and will participate in actives. If she has to go back to a NH I fear she will give up again and not live very long.
It has been a long month and a half with this issue and I just want to figure it out. I even tried talking to her about what would happen if she doesn't try to do better with eating, but you can't reason with dementia.
My own depression and anxiety is bad right now, and I am being told to take a few days away, but it is hard to do that when everyday some one is calling me about her. I don't think there has been a day from January 2016 when I became her caregiver that I have not had to speak for her, run an errand, pay a bill, or many other things.
I really do need a break, but there is always a fire to put out with her. Sigh.
This is every ALF in this area. There is a nurse the aids can call overnight to ask questions or inform them of a situation but not in the building. So I am going to do it. Trying not to go today, but just this evening.
Trying to work and earn some money to pay my bills. OK know I am rambling.
Just wondering if caregiver with a diabetic dementia has seen this before and can give advice.
So if this ALF, and as you say every other facility in the area, has residents with Type 1 diabetes they're on their own with it? It seems bonkers. No disrespect to you to think that surely if you can do this blood glucose check then an aide can be trained to.
I'm really curious. What happens if God forbid you get taken out of action?
I'm sorry you're worried about her having to move, as well. Has the facility actually started making noises about that possibility, or have you discussed with them how they're getting on with your mother more generally?
None of her friends visit either, I know they are just uncomfortable with dementia. But I know she would love to share a meal with them.
The whole it takes a village is true for our aging seniors as well. Everyone seems to run for the hills as we age and don't offer support.
When you say her blood sugar is low in the a.m., how low do you mean? Is it 70 or 40? Low blood sugars should be addressed by her doctor immediately. It's not a let's give it more time thing. It's urgent. So, I'm not sure why the insulin doses have not been reviewed by her doctor and addressed.
It might not be practical, but, there are Continuous Glucose Monitoring devices that alert when the blood sugar goes too high or too low, but, it requires time, energy and attention and it doesn't sound like the staff is up to it. Also, your mom's dementia might cause her to try to remove it.
What are your mom's A1C numbers? They should reveal if she's running too low overall.
I might have a team meeting with the Memory Care staff. They should understand how a dementia patient may say they don't want a plate of food, but, they really do and would eat it, if placed in front of them. And, there comes a time when most dementia patients need hand feeding and they may need to sit and offer it to her by feeding her.
There is just a lot of special dementia care that a Dementia Care unit should have, that sounds like yours doesn't. Can you check to confirm that they are indeed a licensed Dementia Care unit? Their practices sound odd, to me. My LO is in a licensed Memory Care unit and it operates much differently from what you describe.
If things can't be controlled, I'd explore if mom needs skilled nursing with her doctor.
Her lows have been in the 40s and 50s and it is not a wait and see attitude. During the day she is closer to 200. I speak daily with her Primary Care Dr. and the nursing director at the ALF. Everyone is trying to figure out why she awakes up so low. Let me tell you she is very functional at those numbers, you don't realize she is low until you test her.
As I stated earlier she had been in a skilled nursing home and her behavior is horrible, refusing to bath, get out of bed and eat at all. Seriously the nurses don't have time for that, they just checked her every few hours and would give her insulin if she was high or a glucose shot if it was low. And yes she was in three different skilled nursing rehab places and they all did the same thing. So I can understand why my mom was depressed in them. So yes a NH would be able to constantly monitor her diabetes with out limitations but she would just give up and I would be lucky to have her around for Christmas. I want to have some peace and happiness in these last few years, not just to lay in bed and stare at a TV.
A good endocrinologist would figure this out pretty quickly. I'd try to find one pronto. But, keep in mind that the person who is providing injections has to know how to carb count and the food that is expected to eat, must be eaten or you could go too low. She likely needs to have the insulin formula recalculated to prevent these lows. Normally, like with young children, I have read that the key is for the patient to eat the same thing every day at the same time. It's no fun, but, it lends itself to keeping the numbers within a good range.
If there is any chance that your mom is actually a Type II. I'd explore if pills only would work. A good endo would be able to make this determination.
Her short acting is humalog sliding scale. They actually stopped giving it to her at bedtime in hopes that she would stop have the morning lows.
Hoping the the change in long acting will help this situation.
I know Arby's not the best choice, just one of her favorites so I know she would eat some.
Let see how she is when the check her at 7 am.
I noticed that as adults get older, their taste buds adjust where they will eat saltier or sweeter things but instead of adding sugar or salt, add flavors by spices and herbs.
I do encourage you to speak with someone at her location to see if they have a volunteer program to see if anyone besides you can be present with your mother.
Have you tried Glucerna? Many diabetics like Glucerna. This is made specifically for diabetics. Also I ask my diabetic patients that tend to drop in the middle of the night to try to eat a high carb snack - peanut butter on a graham cracker, Skinnypop popcorn, things of that sort. Carbohydrates and protein.
She needs re-evaluation of Trujeo. I would ask to go back to Levemir. In my experience Trujeo has inconsistent results with many patients. Levemir works pretty well and is a lot less expensive as well.
I know you have said you are working with an endocrinologist but the endo needs to change something.
The continuous glucose monitor is a device planted subcutaneously, it beeps when the BS is high or low, & the cartridge needs to be changed weekly. I have a 29 y/o juvenile onset patient now that uses it and while it is very accurate, she says it takes a lot of monitoring.
The continuos dermal patch mentioned above can monitor for two weeks or so and is a good alternative. If your mom doesn't remove it.
Has she been started on prednisone or had any cortisone injections lately say, for joint pain? Any sign of underlying infection? Those will cause blood sugar fluctuations.
Many diabetics get insulin intolerant over the years as well and need higher doses but that is a slippery slope with an elderly person living in AL.
Just throwing out suggestions, not trying to second guess you here.
Review her glucometer for blood sugar results at what time of day.
Does the AL keep a log of when the BS was checked and the amount of insulin given? Do they truly check her BS 4x/day?
Are they giving the correct insulin? I'd look at the bottles myself just to check, but I am a RN and I troubleshoot everything anyway.
Also if possible ask the staff to keep a good diary and take the results to a registered dietician and she/he can tell you how many grams of protein and carbs are necessary specifically for your mom. What is her weight? BMI?
Keep us posted.
6/20 -53
6/21 - 203 (morning after night visit)
6/22 - 179
So hopefully finally things are going better.
So sorry to hear about your mom. Sometimes, it does seem like when it rains it pours, but, no, it's NOT selfish to need a break. it's the smart thing to do, but, I understand how you want to get your mom's blood sugar managed. Managing type I is so challenging. I have cried many times from frustration. It's pretty horrid, but, it's even more difficult when you are trying to do it for someone who has dementia. It sounds like your mom handled it herself since age 16. That's pretty impressive.
Have you heard about the insulin called Afrezza? It's a mist that you inhale through the nose. It's very short acting and taken with meals. I wonder if your mom is able to inhale it, it might help with her highs through the day. I might ask if her doctor is familiar with it. It doesn't hang around long and so it might help avoid her overnight lows. Just an idea.
Also, I'd explore getting your mom on a daily, steady diet of exactly what she likes to eat and figuring out what she needs in insulin. It might be boring to eat the same thing most days, but, she might like that, if it's her favorite food. That might be a way to prevent the lows and highs. If this blood sugar can be managed, maybe her other issues will follow.
Hope it works out, TC, try to get some rest til tomorrow.