{"id":39841,"date":"2020-11-02T00:10:00","date_gmt":"2020-11-02T00:10:00","guid":{"rendered":"https:\/\/srx-tech.com\/?p=39841"},"modified":"2021-07-20T18:46:49","modified_gmt":"2021-07-20T18:46:49","slug":"managing-insulin-for-short-stay-ltc-residents","status":"publish","type":"post","link":"https:\/\/www.srx-tech.com\/articles\/managing-insulin-for-short-stay-ltc-residents\/","title":{"rendered":"5 Strategies for Managing Insulin for Short-Stay LTC Residents"},"content":{"rendered":"<div class=\"wpb_text_column wpb_content_element wpb_animate_when_almost_visible wpb_fadeInUp fadeInUp animated wpb_start_animation\">\n<div class=\"wpb_wrapper\">\n<p><a href=\"https:\/\/www.linkedin.com\/in\/helen-halchuk-755aa01\/\">Helen Halchuk<\/a>, RPH, Director of Client Services at SRX<\/p>\n<\/div>\n<\/div>\n<h3><span style=\"font-weight: 400;\">Managing diabetes in long-term care facilities is a prevailing problem. <\/span><\/h3>\n<p><span style=\"font-weight: 400;\">\u201cDiabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u2014<\/span><a href=\"https:\/\/care.diabetesjournals.org\/content\/39\/2\/308\"><span style=\"font-weight: 400;\">Diabetes Care, American Diabetes Association<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Managing diabetes in long-term care facilities is a prevailing problem. Of the over <\/span><a href=\"https:\/\/www.healthline.com\/diabetesmine\/nursing-home-care-and-diabetes#7\"><span style=\"font-weight: 400;\">1 million LTC residents<\/span><\/a><span style=\"font-weight: 400;\"> in the country, estimates say 25-34 percent of this population has diabetes and is predicted only to grow. On top of that, many of these diabetic residents are more likely to have additional health problems connected with the disease. Combined with the fact that the elderly, in general, have <\/span><span style=\"font-weight: 400;\">multiple comorbidities and many are not well educated in their diabetes management<\/span><span style=\"font-weight: 400;\">, caring for seniors and PWD is an enormously complicated issue.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">I\u2019d like to focus on one specific issue among this population that stands out\u2014the continued difficulty of managing insulin during short stays. Here\u2019s how I\u2019ve seen this problem play out.\u00a0<\/span><\/p>\n<h5><b>A Typical Scenario<\/b><span style=\"font-weight: 400;\">\u00a0<\/span><\/h5>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">A 75-year-old with type 2 diabetes, on an oral agent plus long-acting insulin, gets admitted to the hospital.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">To better manage the fluctuations of her blood sugars, the oral agent and insulin are changed to sliding scale insulin (SSI) based on blood sugar readings taken four times a day.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">On transfer to the post acute facility, the insulin regime started in the hospital is continued.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">At this point, the patient has had multiple medications, and a new or complex regimen might be too difficult for home management. When patients get discharged, how are we to expect them to keep their diabetes under control and adhere to a program?\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Let\u2019s step back and look at how challenges in the care continuum can compound this issue.\u00a0<\/span><\/p>\n<h5><b>The Problem: Transitional Care<\/b><\/h5>\n<p><span style=\"font-weight: 400;\">\u201cTransitions from the hospital or home to LTC, transitions across care settings in LTC facilities, changes in providers, and discharges to the community setting are high-risk times for patients with diabetes.\u201d \u2014American Diabetes Association<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The American Medical Directors Association defines transitional care as \u201cactions that ensure coordination and continuity of care and are based on a comprehensive care plan.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">We know that doesn\u2019t always happen. There isn\u2019t a roadmap or care document that accompanies a patient from one care setting to the next, making transitional care challenging. <\/span><a href=\"https:\/\/care.diabetesjournals.org\/content\/39\/2\/308\"><span style=\"font-weight: 400;\">The ADA<\/span><\/a><span style=\"font-weight: 400;\"> claims discharge summaries often lack information such as diagnostic test results, treatment or hospital course, discharge medications, test results pending at discharge, patient or family education, and follow up plans.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In addition, the following scenarios contribute to the complexity of care, putting residents\u2019 health at risk.\u00a0\u00a0\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Stress-induced erratic blood sugar levels<\/span>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">When the resident moves from the hospital to the post acute care unit, she may become more stressed due to new arrangements. Stress raises blood sugar levels, and therefore insulin may be increased. Controlling these erratic levels is very labor-intensive for the nurses as they need to assess the resident\u2019s BS by finger sticks four times a day. Based on those BS readings, insulin is administered.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Higher risk of serious hypoglycemic event<\/span>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Elderly residents are at a higher risk of the severe consequences of hypoglycemia. Their risk escalates if they don&#8217;t eat because they might not like the food at the home. Physical therapy reduces BS levels, and this can also lead to hypoglycemia.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h5><b>Solutions to Successfully Transitioning Patients &amp; Managing Insulin<\/b><\/h5>\n<p><span style=\"font-weight: 400;\">\u201cA successful transition is a process whereby senders and receivers validate the transfer, accept the information, clarify any discrepancies, and act on the information to ensure a smooth and safe transition of care.\u201d \u2014American Medical Directors Association, <\/span><i><span style=\"font-weight: 400;\">Diabetes Management in the Long-Term Care Setting Clinical Practice Guideline<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400;\">Many challenges build on each other as patients move through the continuum of care. Let\u2019s go back to our 75-year-old who has transitioned from hospital to short stay. How do we give her the tools to succeed with her medication and insulin management at home? Below are five solutions that could provide her and other patients who leave short-stay facilities with a manageable medicine regimen.\u00a0<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Switching to B-BI therapy<\/span>\n<ul>\n<li><a href=\"http:\/\/jamda.com\/article\/S1525-8610(15)00554-X\/abstract\"><span style=\"font-weight: 400;\">A study published by JAMBA<\/span><\/a><span style=\"font-weight: 400;\"> examining SSI versus basal-bolus insulin therapy in LTC residents with type 2 diabetes determined that switching to B-BI therapy appears to be effective, safe, and feasible.<\/span><\/li>\n<\/ul>\n<\/li>\n<li>Combining a GLP-1 receptor agonist and basal insulin\n<ul>\n<li><span style=\"font-weight: 400;\">According to a paper authored by <\/span><a href=\"https:\/\/spectrum.diabetesjournals.org\/content\/29\/3\/152\"><span style=\"font-weight: 400;\">Jennifer M. Trujillo<\/span><\/a><span style=\"font-weight: 400;\">, clinical studies have shown improved glycemic control and low risk of hypoglycemia with this combination.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"font-weight: 400;\">Educate the resident and family during the post-acute stay about the benefits that a healthy lifestyle can have on the resident\u2019s short-term outcomes, including:\u00a0<\/span>\n<ul>\n<li><span style=\"font-weight: 400;\">Physical activity and exercise (depending on age\/ability)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The ADA recommends allowing liberal diet plans and minimizing restrictive therapeutic diets to avoid dehydration and unintentional weight loss.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"font-weight: 400;\">Educate the resident and family about the diabetes medications that she will be discharged home on. The communication should include the signs, symptoms, and treatment of hypoglycemia.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">On discharge, refer the resident to a home health agency and certified diabetes nurse educator for ongoing customized education.<\/span><\/li>\n<\/ol>\n<h5><strong>A Simple Mission<\/strong><\/h5>\n<p><span style=\"font-weight: 400;\">We need to remember that managing diabetes and insulin for those in LTC facilities should be about comfort and quality of life, not prevention. As healthcare professionals, our role should always be to provide the patient and their loved ones with the best practices and medications throughout the care continuum by striving to be more consistent and communicative during transitional phases.<\/span><\/p>\n<p><i><span style=\"font-weight: 400;\">SRX is a technology and advisory company that helps LTC operators realize the lowest net cost on pharmacy spend. We help our customers improve drug utilization, manage pharmacy relationships, reduce costs and waste, and maximize rebates. We are committed to transparency and accountability and guarantee our quarterly rebates are paid on time, every time. Contact us at 833 633 6833.<\/span><\/i><\/p>\n<p>Learn more about our <a href=\"https:\/\/srx-tech.com\/cost-savings\">cost savings opportunities<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Managing diabetes in long-term care facilities is a prevailing problem.<\/p>\n","protected":false},"author":2,"featured_media":39989,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[2,5],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v19.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>5 Strategies for Managing Insulin for Short-Stay LTC Residents - Articles | SRX<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.srx-tech.com\/articles\/managing-insulin-for-short-stay-ltc-residents\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"5 Strategies for Managing Insulin for Short-Stay LTC Residents - 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