📋 How to Be a Caregiver for a Loved One With Diabetes (AARP Article)

[SpringIsHereSoHappy]

There’s plenty you can do to help them live their best life.

By Kim Painter. Published February 12, 2024.

https://www.aarp.org/caregiving/health/info-2024/diabetes-caregiver.html

[SteveW876191]

DISCLAIMER

I am not a doctor, nurse, or medical assistant. I am just a husband that spent 50 years with a type 1 diabetic and experienced everything from peeing on a test strip, to finger sticks, to syringes and insulin pins to the newest and best diabetic care technology in history. 

Here are some recommendations from an experienced caregiver for a diabetic. The very first thing you need to do is look into a Continuous Glucose Monitoring System (CGM). These systems remove the necessity of Finger Stick blood check and I think they are more accurate. They are also checking the glucose level around every 5 minuets. I'd hate to do a finger stick every 2 hours let alone every 5 minuets.  There are some late changes to these systems that are life changing for a Diabetic and the person that assist in their lifestyle. Most CGM now will report Blood Sugar levels through the internet and a smart phone. This allows the caregiver to know what the Glucose level is and take action if necessary. If the diabetic goes too high or low on glucose, your phone will be able to give you a notification. This allows you to make sure that the diabetic is taking action on the glucose problem or allows you to address the problem. This notification is critical for a brittle diabetic at night as they can go into very low levels of glucose which can make them unconscious or not able to think clearly. 

The next thing is to get an insulin pump. This allows the diabetic or the caregiver to administer insulin as needed without using a needle or pin. With a CGM you can program insulin delivery amount in the pump based on reading you receive on your phone or directly to the pump. The reading is provided at the pump via Bluetooth and the phone receives the information through the internet. With some minor training the pump determines the amount of insulin to be delivered, or if reading low, with experience you can determine how many tootsie rolls to chew to bring the glucose level up.

Now the best of both worlds where the CGM communicates directly with the insulin pump. With its computing power it can determine if insulin is required to bring down glucose or reduce the amount of insulin being delivered if too high. Both the pump and phone system will be notified through reports of what was needed, what the pump did, and when it did it and this happens every 5 minuets making the glucose level remain more consistent even if food carbs are not correctly computed or someone is sneaking a snack. 

Now the good news. These new pumps are covered by insurance for reduced cost, covered by Medicare in full including the insulin, and also covered for low-income diabetics. This allows for much better glucose control no matter who you are, your age, or your diet failures. It is always better to control food intake rather than compensate with insulin. 

Now the BAD NEWS. When you go into a hospital, acute care type facility, hospice or maybe nursing homes, these life saving units must be removed due to our outstanding health care system writing laws and policies that prevent their use, when they are the most critical for a person's health.

The reason they require this is due to the liability (CYA) of over or underdosing with insulin provided by a pump which would be extremely rare. Of course, medical staff do not ever misread a finger stick reading, or the amount of insulin in syringe, which they must use due to them using finger stick testing and syringe or pin insulin injection.

I am hoping that people that monitor or are diabetic will start complaining with the Washington and state representative that this removal of pumps and CGM must stop, as I know of one person, (my wife) that i feel was poorly administered insulin by the staff of both hospitals due to these national policies and acute care facilities, that passed away. 

Look into these CGM and pumps as they are life savers. 

[GailL1]

@SteveW876191 

Good post - and important.

You may find this interesting and it supports your claim - research is ongoing but it seems that the research already points to regulatory changes in regards  tousing CGMs.   Evidently this became more apparent during the Covid pandemic.  

NIH.gov 10/01/2023 - Continuous glucose monitoring for inpatient diabetes management: an update on c...

From the link:

For the last 3 years, CGM has become part of the regular care for glycemic management for hospitalized patients mainly not only in the US but also in the UK and Europe. Consequently, societies are developing guidelines to create a consensus on the use of CGM for inpatient hospital use, and manufacturers are pursuing formal regulatory approval to allow current and new users access to CGM during hospitalization. The sole use of CGM or in combination with POC will be determined by care team experience and precise guidelines. What is certain at this time is the capability of CGM to provide better tools in predicting patient glucose trends which will guide appropriate treatment decisions and achieve better glycemic control for patients experiencing dysglycemia while in the hospital.

… CONCLUSION 

Over the last few years, CGM has revolutionized the care of patients with diabetes in the ambulatory setting, increasing its use and replacing self-monitored glucose testing as standard of care for some patients. It is expected that these innovative changes will need to be translated to the hospital setting. While this process usually takes time, since the COVID pandemic, there has been an urgency to move this field forward dictated by patient and clinical needs and limited resources and staffing. We have seen the rapid and exciting spread of CGM use in the hospital setting over the last few years, and optimistically anticipate a continued movement to improve glycemic monitoring and diabetes care in hospitalized patients with newer diabetes technology.

So, yes these regulatory changes need to be made and the staff needs to have the education and training to use then in not just the hospital setting but other environments too like skilled nursing homes. 

If family caregivers can learn it then so should other caregivers no matter what their level of expertise may be or environment where they work.

That also includes learning when it has to be removed for specific treatments and imaging -