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Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients

Diabetes is a serious illness affecting many nursing home residents.  Diabetics face an increased risk for a variety of health problems and complications, including ketoacidosis.  Diabetic ketoacidosis is a dangerous complication of diabetes that occurs when you don’t have enough insulin in your body.  This serious complication is more common in people who have type 1 diabetes, rather than type 2 diabetes. 

iStock_000001089443XSmallDiabetic ketoacidosis develops when you have too little insulin in your body, raising your blood sugar level.  This causes your body to break down fat for energy, creating toxic acids known as ketones.  If left untreated, this can cause you to lose consciousness and even result in death.  Symptoms develop quickly and include:

  • Excessive thirst
  • Frequent urination
  • Nausea and vomiting
  • Abdominal pain
  • Loss of appetite
  • Weakness or fatigue
  • Shortness of breath
  • Fruity-scented breath
  • Confusion. 

Doctors can test for high blood sugar level and high ketone level in your urine in order to confirm ketoacidosis. 

Ketoacidosis is commonly triggered by an illness or a problem with insulin therapy.  Elderly diabetic nursing home residents are more susceptible to infection and other illnesses, which in turn puts them at greater risk for developing ketoacidosis.  However, the risk of ketoacidosis is highest if you are age 19 or younger and suffering from type 1 diabetes.  Other possible triggers include: stress, physical or emotional trauma, high fever, surgery, heart attack, stroke, and alcohol or drug abuse. 

Treatment of ketoacidosis is done with fluid replacement, electrolyte replacement, and insulin therapy.  These very treatments that are used to correct ketoacidosis are also the source of most ketoacidosis complications.  These complications include: low blood sugar (hypoglycemia), low potassium (hypokalemia), and swelling of the brain (cerebral edema). 

The best way to prevent ketoacidosis is to properly manage your diabetes with healthy eating and physical activity as well as monitoring your blood sugar level to ensure that it remains within your target range. 

Many nursing home residents rely on nursing home staff to properly monitor their blood sugar level and adjust insulin dosage as needed as well as provide healthy and well-balanced meals.  Therefore, it is important that nursing homes develop care plans to provide adequate care and services to manage diabetic residents.  Most diabetic complications develop faster in elderly diabetics with poor glycemic control.

Diabetes in the Elderly

Diabetes is a serious disease that can cause many complications for elderly diabetics.  Ketoacidosis and other diabetic complications require that nursing home staff take special precautions to properly monitor diabetic residents and ensure that they receive necessary care and services to attain and maintain the highest quality of life possible. 

If you worry that a nursing home facility is not providing adequate care to manage your diabetes, it is important that you take immediate action to get your diabetes under control and prevent medical problems and complications. 

Resources:

Medicine Net: Ketoacidosis

Diabetes Disease: Ketoacidosis

Journal of Geriatric and Gerontology: Diabetes in the Elderly

Resident Grand Rounds: Diagnosis and Management of Diabetic Ketoacidosis in Adults

Nursing Homes Abuse Blog:

Nursing Homes Must Be Prepared To Handle Diabetic Patients

Never Event #3: Poorly Controlled Blood Sugar, Hyperglycemia & Hypoglycemia

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  • Dena Clarke

    Where to go next? I recently lost my mother to what we presume is diabetes. My mother had been in hospital and had excellent treatment for six months. In England we have a visit from a nursing home to establish whether they can meet the needs of people when they leave hospital and as my mother was to need to have insulin injections this happened to her. The nurse who came out said they could cater for her needs. Just before my mothers arrival to the home my daughter and I heard a conversation between a nurse and the manager of the home which disheartened us. The nurse was worried she wasnt experienced enough with the sort of diabetes my mother had and the manager consoled her telling her to have more confidence and she would send her on a training course. The next nurse had to be assisted by my 21 year old daughter to use a blood sugar monitoring device as she had not seen one before, even though my daughter had been using one in her caring job at the local hospital for over a year.Warning bells sounded and after lots of other unsatisfactory things happened in the home I emailed BUPA direct. On the day my mother passed away she displayed all the symptoms of slipping into a diabetic coma and I told the nurse but there was no urgency and no dr called as he was due to come out the next day. One nurse had been concerned about my mother not eating, her diet was not catered for and she had lost weight since she had entered the home. She was only there six weeks. I have written to the home and said I feel as if they should not have taken on a patient without the staff adequately trained to deal with her needs. Am I doing wrong? What happens next? help please, Dena

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