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August 16, 2007

Other, Type 2

Question from Mt. Vernon, Texas, USA:

My 85-year-old mom arrived in Lewisville to be closer to family, after living in Chicago for 31 years, to an assisted living facility on July 7, 2007. My brother and sister-in-law have helped mom move in and get settled. My niece and nephew are thrilled that grandma is now living minutes away. Mom was comforted knowing that family is there for her. On July 14, I spoke with my mom before bedtime asking me what she should eat and told me she had been nauseated with vomiting earlier in the day, but did eat a light dinner. I asked mom to check her blood sugar, which she told me was in the 170s mg/dl [9.4 to 9.9 mmol/L], but she was diaphoretic. My brother was called and mom was taken to the Emergency Room within 5 minutes with dehydration and hypertension. She received hydration and was admitted for evaluation and treatment. While in the hospital, mom was on an insulin sliding scale and did have sugars more than 200 mg/dl [11.1 mmol/L] that required a dose of insulin. She was discharged on the 16th, and to my surprise, did not receive any dietary guidelines. My brother did have my mom to meet her new family practice doctor days before hospitalization. My concern is that she is not scheduled to see her doctor until August 13. Her initial appointment with an endocrinologist is not until September 13. This past weekend, mom again had a hypoglycemic episode, but recovered after eating. Now, when she gets up at 6 a.m., she is checking her blood sugar, eating a light meal, and rechecking her blood sugars two hours postprandial. Mom is feeling better and, today, plans to call her doctor and endocrinologist to try to get an earlier appointment. Mom needs patient teaching, to meet with a dietitian and her endocrinologist as soon as possible so that she has an understanding of her diabetes, with family teaching and after care. Beloved family members need support and teaching. Knowledge is empowering and my mom has a desire to learn and maintain her independence for as long as possible. She is an innocent, dependent on those entrusted to her care to facilitate her well being. I wonder if the ball was dropped somewhere. Patients deserve to be treated with dignity, respect, and our seniors need advocates to help them in the process. This is a deserved payback for the hours of love and care my mom gave raising five children. I love my mom very much and realize we all need others to help us. My mom is open to living, learning and enjoying her new life. So, is it the standard to discharge a diabetic patient without teaching before discharge, to facilitate matters so that patient's needs will be addressed?


My response to your question is that a comprehensive plan for diabetes care would have been the best outcome at discharge. If she did not receive this, you might try talking to her physician who was in charge of her care in the hospital. Many times, the diabetes-related services provided in the hospital are also available as an outpatient. If all of her care could not be coordinated during a short stay, than some type of outpatient plan would be very reasonable. Since I do not have the medical summary for your mother’s care, I am not able to comment on all the medical therapy she received. I think it is the things we don’t know as patients that make us the most nervous and concerned. It sounds like she needs some reassurance and contact with professionals that are experts in diabetes care. Many times, the diabetes care team, made of up nurses, dietitians, therapists, and physicians’ assistants are also highly qualified to provide diabetes education outside the physician’s office. You might check with your mother’s local physicians how you might contact these people to get a head start on education even before she meets with her physicians in August and September.