How can I get my diabetic mom with dementia to eat more?

(((((((hugs))))) - hope you can get some rest tonight. Looks like the palliative care doc is unsure of what is happening too. Hope you get some clear direction soon.

Hi Everyone, It is Wednesday (6/28) evening. I am home, mom is in ICU. They still can not get her sugars in control. I think everyone is just unsure as to why.

Talked to a palliative care doctor, can't say how I really feel about that. He was very understanding and mostly asked questions. He wants to give it a few days to see where mom is at and then he can recommend a plan.

Emotionally and Physically tired plus just unsure of what is happening.

Thinking of you, Tatoochick. Take things day by day!
A lot has been going on with you and your mom lately. Glad she is being cared for.

Tattoochick
How exhausted you must be - hospitals and waiting for hours

I hope you can rest
How's mom tonight ?

OK, now mom is in ICU, because they still are having issues with getting her sugar in control and want her on an insulin drip. Palliative care doctor stop in ICU put does not want to talk to me until tomorrow. Sign.

Tuesday, still at hospital. Here we are again mom's sugar is all over the place. They want her to be on an insulin drip. Sigh. Get this, physical therapist was in the room then I got there. I helped him work with her. He feels that she can go to rehab and with pushing get up and walking. Yes she is physically strong, but mentally does not want to.
They after that the nurse tells me the doctor recommends palliative care. So what does this mean, nurse says she will have doctor come talk to me. I am tired and have no fight left in me to deal with this right now.

Here I sit, waiting basically by my self since mom just can't understand.

Good for you to take her for evaluation. Those low blood sugars in the middle of the night, or at any time, are not good for your mom. Her fall risk increases- I know you know all this.
I too agree- keep her higher at night for awhile. Treat her infection, push fluids too. You can add Glucerna if she is eating like a bird to supplement.
Hope she feels better soon! Get some rest, daughter. 

Mom's BS are going well, they put her back on her regular insulin schedule yesterday afternoon, with some tweaks of course. However she id being my stubborn about food today. As if that is possible, she does seem to be mentally off today. Behavior is very child like, doesn't see to understand things today. I know that can happen when they are in the hospital and all the stress of things lately, but is worrisome. Guess we shall see what the doctor says.

Find a nurse practioner CDE or Pharm D CDE (certified diabetes educator). For older people with problems, the goal IS NOT an A1c less than 7%. It can be 8-8.5%. However, since your mom has type 1, she must have insulin or she can go into DKA quicklyRemember her mealtime insulin (novolog or hum along) does not last long. It is imperative that she have her long acting insulin everyday. Also, infections increase BG even if the person is not eating.

Take her to a dietician.

@answry Thank you for sharing let me know how things go with your dad.

Mom's primary doc and endocrinologist don't agree either. I am leaning more towards the primary care who also says lets let her run a little high and not to give her any insulin when she is lower then 175. Which is really the evening one since she was having the lows in the morning. I guess we have to see what happens after this infection clears up.

Haven’t posted in forever but wanted to pass my father’s history. Dad has Type 2 diabetes and is on Levemir. Doctors don’t agree on to insulin or not to insulin and they don’t agree on what amount of insulin. For example; his primary doctor wants him on 5 units a day regardless (even at 140, 120, etc). Several doctors he has seen in larger cities (during knee and prostate surgery) say with his numerous medical issues, we need to let his sugar run high.

Well the primary insisted again and we had him start the 5 units a day. Needless to say father started having issues. He was staying dizzy, confused, couldn’t gain energy (as much as 83 year old can have), and was losing his balance. We moved his shot from mornings to night when he would probably eat more. Finally he had a fall where he bumped his head. After that, I begged them to take him back off the insulin because that was the only thing different.

We haven’t had any other incidents. With that being said, he does have an appointment with a neurologist to make sure nothing else is going on medically.

Hope she gets the help she needs.

Yes, this morning says her blood culture definitely so an affection / virus. After three weeks of this crazy back and forth, hoping all gets better. Since she has been admitted and getting antibiotics her sugar has been between 100 and 189. Yeah! Fingers crossed.

@Sorrynotsorry It took me and the help of three other people to find this ALF w/memory care that would take her with the siding scale insulin. They actually hire an outside home health company to come in and take care of all the ALF patients that need injects and certain medications (they have in house med techs, a nurse RN for the memory care floor from 7 am to 6 pm.) Home health checks her 3 times a day (two covered by the monthly "rent" and one I pay extra for. It is well worth it to keep her out of a NH. There are some seriously nice NH in the area, but it still feels like a hospital and my mom hated it also. Really trying to keep her at ALF for as long as possible.

My FIL does not qualify for assisted living because he has his blood sugar level tested four times a day. The insulin based on that reading. AL do not provide skilled nursing so he's in a NH and hates it.

Heck no! You've been dealing with those BS 3-4x/Day & what, 3 ER visits? I thought she may have an underlying infection messing up her blood sugar.
Hope it works out, TC, try to get some rest til tomorrow.

((((((hugs)))) - not selfish at all. You need a break. Hope it is nothing serious and gets treated easily and all settles down. It could affect her bs too,

Tattoochick,
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.

The never ending tale ... this morning we are at the ER as it looks like mom might have an infection of some kind, white cell count is elevated. Is it selfish to want a break from this. June has been not stop health issues.

The newest basal insulin is Tresiba. It is made by Novo Nordisk; the same company who makes Levemir. It has been shown to significantly reduce hypoglycemia compared to other basal insulins. Excellent choice if your insurance covers it. Also remember the goal for your mom is to prevent hypoglycemia. She does not need an A1c of 7. For her age and dementia, maybe an 8.5% and not having DKA

So mom's reading the last three mornings
6/20 -53
6/21 - 203 (morning after night visit)
6/22 - 179

So hopefully finally things are going better.

I think the Continuous Glucose Monitor is a good idea, however, when someone has dementia, they may not tolerate it well, pull it out, hide it, etc. They may not be able to understand why it's there and if they do, they may forget. It's a challenge to even keep dentures and eye glasses on dementia patients. Plus, when it alerts, the staff need to be aware and know how to respond. Based on what she says, I'm not sure they are trained in how to handle her condition.

Humalog/Novolog is fast acting and it is imperative she eats if she is taking this. Who does her BS and provides the Humalog coverage? Surely she does not?
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. 

tattou -to keep her bs up at night she needs to eat protein for her bedtime snack. It works better than complex carbs. Chicken in any form would be good.

Tattoochick, how was Mom's glucose level this morning?

have an endocrinologist put a freestyle Libre continuous glucose sensor on your mom. It will record blood glucose every 15 minutes for 2 weeks. The doctor can download the data and make insulin adjustments based on the patterns seen. A sensor is only $60 and requires no meter calibration.

From my experience, residents with dementia responds to colors. Make her plate colorful and food that are easy to digest so it will be easier for her to eat. Sometimes warm soups are good because you can add all the necessary vegetables.

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.

She was 215 and then she ate about 60 grams of carbs? Did she have a humalog shot before eating? Do let us know how the morning finger prick goes. Sure hope eating something helps!

Just FYI just got home from checking my mom's sugar. She was 215 and then I got her to eat a chicken tender and small fries from Arby's, a banana and half a Glucerna shake.

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.

Got it. Levemir is what I take. Many take it twice a day ..once in the a.m. and once at bedtime. That way, you have more control. Some people need greater help during the day than overnight. With that adjustment and maybe, reevaluating her sliding scale formula, they can get it right. I hope it works well for her.