The following was reported in the McKnigths news, February 4, 2016

Hypoglycemia and care transitions are among the topics in the first-ever guidelines relating to diabetes management in long-term care facilities.

“Management of Diabetes in Long-term Care and Skilled Nursing Facilities,” released Tuesday by the American Diabetes Association, highlights the differences in diabetes management for younger and older people. The guidelines primarily focus on type 2 diabetes, since the majority of diabetic long-term care residents have that type, according to the ADA.

For older diabetes patients, especially those needing long-term care, hypoglycemia risk, commonly known as low blood sugar, is the most important factor in determining glycemic goals, the guidelines warn. Long-term care residents need plans that strike a balance in maintaining glycemic levels, the guidelines suggest.

Long-term care facilities should also avoid sole use of sliding scale insulin, as it leads to wide variations in blood glucose levels, is a burden for patients and uses up more nursing time and resources, the ADA notes. Liberal diet plans are also preferable for diabetic residents, compared to therapeutic diets, as more food choices benefits nutritional needs and glycemic control.

Blogger comment:

I quote from above … “Liberal diet plans are also preferable for diabetic residents, compared to therapeutic diets, as more food choices benefits nutritional needs and glycemic control”.  I have managed skilled nursing facilities for 30 years and have tried all the academic solutions including the so called liberal diet plans … the results were demoralizing … weight gain became the problem (not the issue as the bureaucrats call it) resulting in increased multiple chronic diseases needing hospitalization, re-hospitalization and ER usage.

Diabetes continues to be the leading health problem since it also the underlying cause of heart attacks, strokes, obesity, respiratory failure, cancer, etc.  It is fine that the Diabetes Association is finally becoming active in Long-term Care … but too little and too late.  While we focus on treatment because the patients are already far down the road to end of life and not on prevention is puzzling.  What I found as an Administrator of a Skilled Nursing Facility is the clientele is changing dramatically.  For example the average age  used to be 85 years old with 82% female.  The average weight was 150 pounds including the lighter females.  Today the average age is 71, the average number of females is 51% and the average weight is 271 pounds.  The point is the horse left the barn ages ago.

This is a social and physician problem.  It stems from our society not taking responsibility for their own self-health and the physician’s main weapon to combat the diseases I listed as being connected to diabetes is a pill and the “watch the carbs” warning.    We are finding that diabetes and obesity are connected to the brain not the body.  Drug use, lack of any exercise, lethargy, stress levels out of sight, pressures of the poor economic future, political games played with the taxes, poor family life, lack of hope and faith in the future, etc. are driving us all towards a nursing home too early and to the hospital too late.  As an outcome the country will decline, quality of life will decline and other countries will wonder why we are always shooting each other as well as them.

The solution, in my opinion, if you allow me one, is stop accepting the focus on disease codes and focus on the problems that cause these diseases.  A simple problem statement given to the physician, that needs a solution, is a good start. Then a collective care plan (physicians don’t have care plans just a disease and medication reference book) focusing in on life style, drug use, exercise regimen, family life, stress levels, mental and physical health history.  Then design a personalized set of interventions to pursue goals of improvement … with time frames and benchmark dates for measuring outcomes.  The priority is personalized self-health not population health being promulgated by the bureaucrats and politicians so they can blame everyone but themselves for the poor health of Americans.

Is it even feasible to contemplate doing it right or  are we going to continue to just accepting what we are told about our lives?    Self-help books, seminars, videos, DVD’s, CD’s have helped millions of Americans to live with a better mental attitude, life style and quality of life.  Why not use Self-health books, seminars, etc. for better health and a longer life.  Take the responsibility away from the doctor and hospital to save you from yourself and deal with your physical condition as well as your mental condition.  In my book “Never too Late to Live” I define self-health and provide you a means to and end … a better and longer life … because prevention is worth 300 million pounds per month weight loss for overweight Americans if the proposed program is followed.  And this will save the bankrupt health care budget $300 billion per year wasted on inefficient and ineffective treatment driven health care services.

Also, a great source of a personal health analysis can be accessed on the internet that measures your biological age versus your chronological age.  Over 75% of Americans are aging faster than ever and their biological age is higher than their chronological age … in other words you may be 30, a little overweight and unhappy with yourself and your biological age is 40 due to this stress.  Every doctor in the world should be using this comprehensive mental and physical health evaluation … your score will predict your life expectancy unless someone shoots you with their concealed weapon.  Dr. Oz and Dr. Roizen have collaborated on this scoring process.

Millions have taken Dr. Oz and Dr. Roizen’s RealAge® Test. www.realage.com. Find out how old you really are.  Go to their web site or other biological calculators http://www.biological-age.com/# and get your score.  Shari, my wife of 56 years, and I are in our mid 70’s and we test out in our mid 50’s so develop your own life expectancy plan using my book “Never too Late to Live, Never too Late to Change” at Amazon or any book store site.