Diabetes Care in Nursing Home

Diabetes mellitus is a chronic disease that requires careful blood sugar monitoring and proper nutrition. If diabetic nursing home residents don't receive the care they need, they could suffer severe complications, such as hyperglycemia, kidney failure, heart disease, and even death.

Unfortunately, many nursing home patients with diabetes don't receive adequate diabetes care. The failure to provide proper diabetes management is considered nursing home neglect.

Did you or a loved one suffer injuries from poor diabetes care in a nursing home? If so, Nursing Home Law Center LLC can help you hold the negligent parties accountable for their actions. Our skilled personal injury attorneys help victims of neglect, abuse, and medical negligence seek financial compensation from nursing homes, skilled nursing facilities, and other healthcare institutions.

Contact our nursing home abuse lawyers at (800) 926-7565 for a free consultation.

What is Diabetes Mellitus (DM)?

Diabetes is a chronic health condition that affects how the body uses blood sugar (glucose). Glucose is a simple sugar that is an energy source for living organisms. In humans, glucose is the body's primary energy source for the brain, muscles, and tissues.

When you eat, the body breaks down most of the food into glucose and releases it into the blood. The increase in blood sugar signals the pancreas to release insulin, the hormone that regulates the amount of glucose in the blood.

With diabetes, the body doesn't produce enough insulin or can't use it properly. A lack of insulin causes excess sugar in the blood, increasing the risk of severe health problems over time, such as heart disease, kidney disease, and vision loss.

Two Main Types of Diabetes Mellitus

There are two main types of diabetes:

• Type 1 Diabetes: In Type 1 DM, also known as insulin-dependent diabetes, is a chronic condition wherein the pancreas does not produce enough insulin. Type 1 DM usually appears during childhood or adolescence. A person with Type 1 diabetes requires lifelong treatment.
• Type 2 Diabetes: This type of DM involves impaired glucose regulation. It can be caused by the pancreas not producing enough insulin or the body responding poorly to insulin. The onset of Type 2 DM is usually during adulthood but can also start during childhood or adolescence.

Another type of DM is gestational diabetes, which develops in pregnant women with no history of the condition. It occurs when the body cannot produce enough insulin during pregnancy.

There is also prediabetes, wherein blood sugar levels are higher than usual but not high enough for a Type 2 DM diagnosis. Prediabetes increases the risk of Type 2 DM, stroke, and heart disease.

Gestational diabetes and prediabetes are reversible with correct interventions. Some people with Type 2 DM can reverse their condition with drastic weight loss and lifestyle changes.

Risk Factors for Diabetes

The following factors may increase your risk of diabetes:

• Family History of Type 1 DM: If you have a family member with Type 1 DM, you could be at risk of developing the same condition. You can undergo a test to determine the presence of diabetes immune system cells (autoantibodies) that may indicate an increased risk of Type 1 DM.
• Certain Races or Ethnicities: Black, Hispanic, American Indian, and Asian American people have a higher risk of developing Type 2 DM, although the reasons remain unclear.
• Being Overweight or Obese: Prediabetes, gestational diabetes, and Type 2 diabetes is more common in individuals who are overweight or obese.

The American Diabetes Association (ADA) recommends taking an A1C test to identify prediabetes and diagnose diabetes. It shows your average blood sugar level for the past two to three months. If you think you are at risk of diabetes or are looking for a better way to monitor your sugar levels, ask your doctor about the A1C test.

Symptoms of Diabetes

The presence of diabetes symptoms depends on your blood sugar level. Some individuals with prediabetes or Type 2 DM may not experience symptoms. In Type 1 DM, however, the onset of symptoms is often rapid, and they are usually severe.

Common symptoms of Type 1 and Type 2 DM are:

• Increased thirst
• Frequent urination
• Losing weight without trying
• Fatigue and weakness
• Blurry vision
• Irritability and other mood changes
• Slow-healing sores
• Frequent infections
• Presence of ketones in the urine

See a doctor if you experience one or more of these symptoms for an extended period. Diagnosing and treating diabetes as early as possible will help increase life expectancy and avoid severe complications.

Complications of Diabetes

Uncontrolled diabetes or poor diabetes care can lead to the following complications:

• Cardiovascular and Microvascular Complications: Over time, diabetes can damage blood vessels and the nerves controlling the heart. Diabetes significantly increases the risk of heart and blood vessel problems, such as coronary artery disease, heart attack, stroke, and atherosclerosis (narrowing of the arteries).
• Nerve Damage: Excess sugar in the blood can damage the walls of capillaries, especially in the legs. This damage can cause tingling, numbness, or pain, usually beginning at the tips of the toes or fingers before spreading upward. Neuropathy in the nerves related to digestion can cause vomiting, diarrhea, nausea, and constipation. In men, nerve damage may cause erectile dysfunction.
• Kidney Damage: Diabetes can damage the kidney's blood vessels that filter waste products from the blood. Diabetic kidney damage (nephropathy) can lead to complications such as fluid retention, high blood pressure, anemia, and end-stage kidney disease.
• Eye Damage: Many diabetic patients lose their eyesight over time. When diabetes damages the blood vessels in the eye can lead to vision loss.
• Poor Circulation in the Feet: Neuropathy or poor circulation in the feet can lead to foot complications. A common complication is a diabetic foot, characterized by numbness, tingling, pain, and loss of sensation in the feet. A wound or sore on a diabetic foot may become infected and cause gangrene, as diabetes causes poor wound healing. Amputation may be necessary to prevent further complications.
• Skin and Mouth Problems: Diabetes increases the risk of bacterial and fungal infections and other skin problems.
• Hearing Loss: Diabetic patients are more prone to hearing problems.
• Alzheimer's Disease: Type 2 DM may increase the risk of dementia.
• Depression: People with Type 1 and 2 DM are susceptible to experiencing depression symptoms.
• Geriatric Syndromes: Diabetes can cause common geriatric syndromes in elderly patients, such as cognitive impairment, falls, depression, urinary incontinence, and chronic pain.
• Death: Managing diabetes incorrectly can reduce life expectancy due to heart disease, kidney failure, infections, and other complications.

Diabetes Care in Nursing Home Settings

The goal of diabetes management is to maintain normal blood glucose levels (glycemic control) and, in the process, create the best possible quality of life for patients.

The American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association collaborated to recommend diabetes care guidelines for nursing home patients. According to these sources, proper diabetes care in nursing homes and skilled nursing facilities should include the following:

Diabetes Assessment

Nursing homes and assisted living facilities should assess all new nursing home residents with diabetes. The process must include recording the following information:

• Average blood sugar levels or A1C reading
• Blood pressure
• Brand and type of insulin injections used
• Frequency of blood sugar monitoring
• Family medical history
• Home diabetes medications
• Length of disease
• Other health conditions and medications

Diabetes care is not a one-size-fits-all plan. Assessing each new patient's condition will ensure that all diabetic residents receive individualized care plans that fit their unique requirements.

Blood Sugar Monitoring

Diabetic residents must have blood sugar levels within a normal range and with little changes. Nursing home staff can use glucose meters to monitor patients' blood sugar daily.

Testing frequency depends on the type and severity of the condition. Staff should test patients with Type 1 DM 4 to 10 times a day, while Type 2 patients need testing between meals and before sleeping. Missing a blood sugar test can easily lead to a patient developing poor glycemic control.

Diabetic Medications

Type 1 diabetes requires insulin injections, while Type 2 may have varying care plans depending on the patient. For residents with Type 1 DM, nursing staff must administer insulin on time and in the correct amounts to keep blood sugar within the normal range.

Residents with Type 2 DM can manage their condition with a healthy diet, exercise, and oral medications. Some may need insulin injections if lifestyle modifications and oral drugs are insufficient to stabilize their glucose levels.

According to the American Geriatrics Society (AGS), clinical intervention from nursing staff can help older adults manage their condition. Failing to give patients insulin on schedule may be considered medical malpractice.

Medical Nutrition Therapy

A big part of diabetes care is providing proper nutrition to elderly diabetic patients. Food, particularly carbohydrates, can quickly spike blood sugar levels.

Nursing home staff must ensure that older adults with diabetes receive the correct quantity and type of food for every mealtime. Too much food and carbohydrates can cause hyperglycemia and increase the risk of complications. Too little food, on the other hand, can cause a blood sugar drop, especially if the patient takes basal insulin.

Furthermore, nursing homes and assisted living facilities must ensure that older adults with diabetes receive adequate macronutrients (carbohydrates, protein, fat) and micronutrients (vitamins and minerals) to prevent deficiencies. Patients need individualized plans as every person has unique nutritional needs. For instance, a diabetic resident may need fewer carbohydrates but more protein for wound healing.

Skin and Hygiene Monitoring

Proper management of diabetes should also include skin and hygiene monitoring. According to the Centers for Disease Control and Prevention, diabetic patients are at risk of foot neuropathy, which could lead to infection if staff fails to detect an untreated wound on the foot. Some patients may suffer from loss of sensation, increasing the risk of bedsores if they are immobile.

Hygiene monitoring is another essential part of diabetic care. Nursing staff should check diabetes patients with urinary incontinence at least a few times daily and ensure they receive hygiene assistance (e.g., changing diapers). Otherwise, urine and other waste materials can cause infection (if a wound is present) or make the skin more prone to damage.

Other Recommendations from The American Medical Directors Association and American Diabetes Association

Care plans for managing diabetes can also include the following:

• Fall Prevention: Elderly diabetic patients have an increased risk of falling due to hypoglycemia (low blood sugar). This condition causes dizziness, lightheadedness, and balance issues. According to the American Medical Directors Association, nursing homes must have proper fall prevention protocols and strategies to protect diabetic residents from falls.
• Infection Control: According to the Centers for Disease Control and Prevention, bloodborne infections like Hepatitis B are more common among nursing home residents. These conditions are often caused by using the same tools or insulin injections on more than one patient. Health care providers must ensure that needles are never shared and disposed of properly.
• End-of-Life Care: Nursing homes should provide end-of-life support to terminally ill older adults. Clinical practice guidelines include close blood sugar monitoring to prevent complications and increase the quality of life.
• Safer Insulin Administration: ADA, AMDA, and the American Geriatrics Society recommend against sliding scale insulin therapy, deeming it ineffective for most older adults with diabetes.

Inadequate Diabetes Care is Nursing Home Abuse

Some nursing homes stray from diabetes care standards and cause harm to nursing home residents. Whether a simple accident or an intentional act, causing harm to a resident may be considered nursing home abuse.

Diabetic nursing home abuse includes:

• Failing to assess risk factors for diabetes complications
• Not administering insulin and other diabetes medications on time
• Not providing proper diets to diabetic residents (feeding patients too much or too little)
• Not monitoring patients' blood sugar
• Not testing for urinary tract infections, nerve damage, and other complications and treating them accordingly
• Failing to prevent fall accidents

Causes of Poor Diabetic Care in Skilled Nursing Facilities

Nursing home residents are more likely to experience nursing home abuse and poor care if their facility suffers from the following issues:

• Understaffing: A lack of employees can lead to inadequate care and attention for some nursing home residents.
• Poor Education and Training: Nursing staff needs proper training, education, and experience managing diabetes to provide appropriate care for all residents. Otherwise, medical mistakes are more likely to occur.
• Inadequate Staff Management: Poor leadership can lead to a lack of accountability among staff, reduced productivity, and poor care for diabetes patients.

Nursing Home Abuse Lawsuits for Improper Management of Diabetes

All nursing facilities are expected to provide high-quality diabetes care to all patients. Unfortunately, some nursing homes provide poor care and treatment, causing harm to elderly patients.

If you or a loved one suffered an injury due to poor diabetes care in a nursing home, filing a nursing home abuse lawsuit could help you recover financial compensation.

Evidence

In all nursing home abuse cases, the burden of proof is on the one bringing forth the lawsuit (plaintiff). You must prove that the nursing home (defendant) more likely than not caused your injuries.

Your nursing home abuse lawyer can use the following forms of evidence to prove the defendant's negligence:

• Medical records
• Prescriptions
• Nursing home records
• Photos of injuries
• Glucose meter readings
• Victim's testimony
• Medical expert testimony
• Witness accounts from nursing staff, family members, and other residents

Compensation

Diabetic nursing home residents who suffer harm from a facility's negligence deserve financial compensation for their injuries and other losses. Filing a nursing home abuse claim could help you recover compensation for the following:

• Medical bills
• Disability
• Pain and suffering
• Loss of quality of life
• Wrongful death
• Punitive damages

Discuss Your Case With an Experienced Nursing Home Abuse Lawyer

All nursing home residents deserve proper care and attention, especially if they suffer from a chronic condition such as diabetes. But, sometimes, nursing homes fail to manage patients' diabetes correctly, causing further harm, injury, and even death.

Did you suffer an injury or illness due to a nursing home's negligence? Or did your loved one die because their nursing home failed to manage their diabetes? If so, Rosenfeld Injury Lawyers can help you obtain the financial compensation you deserve.

Contact our nursing home abuse attorneys at (800) 926-7565 or use the contact form for a free consultation. All confidential or sensitive information you share with our legal team will remain private under an attorney-client relationship.

Our lawyers handle all accepted cases on a contingency fee basis. This agreement ensures you do not have to pay for our legal services unless we win your case.

Resources:

• CDC - About Diabetes
• Mayo Clinic - Understanding Diabetes