80 YO female, has been insulin dependent for 18 years
was taking novalin, twice daily once before breakfast and the second time right before bedtime (4-6 cc each time) also takes micronease with each meal
suffers a fall and trapped on floor for eight hours, when found she is taken to emergency room where she is admitted to the hospital to be treated for for a severe urinary rack infection, given catheter for 5 days until deemed medically stable and then sent to “rehab facility” to regain strength to walk again
upon arrival at “rehab center” read old folks home, doctor at facility is told about her current medical regime of Novalin and micronease. Doctor ignores this and puts her on novalog three times a day right before meal as well as at bed time. The only reason I say nothing is that for the first time in a week I see my mom with a smile on her face, and she is happy with the staff etc.
currently taking 12-18 units daily
each test before meal blood sugar is in 200-350 range
son talks to doctor asks # of insulin treatment prescribed, he say three, once b4 each meal. Son returns to home, asked nurse at home and told 4 times, last time being right before bed. Son goes back and asks doctor again and he says yes only three and when told she is getting four times a day he says that I must be mistaken and he would call nurse to follow up on, but he never does.
when I finally tell the nurse this she becomes indignent and calls up doctor herself, comes by my moms room and says OK, the doctor said only three times a day before meals as previously discussed.
I ask the nurse why even in the documentation that comes with novolag in every package it says that novalog is to be used in conjunction with a long lasting insulin as part of a diabetic treatment regime, and why was she receiving no long lasting.
Her response was well we don’t know her so… but she readily agrees that just giving her novalog is just playing ping pong with her blood sugar level as novalog is only effective for 3-5 hours, and they are testing her blood sugar before each meal, which is roughly 5 hours apart so of course the readings are on the high side
told next night at bed told that they start to give my mom lantus (long lasting insulin) at bed time
next day discuss case with head nurse at home, she pulls chart notices that the doctor put in chart on 9.12 patient is to receive NO long lasting insulin
on 9.13 day after I talked to the other nurse about her insulin regiment, he now prescribes lantus at bedtime
mother given blood tests on 9/12, results come back with her HgbA1c rating coming back at 12.6 which I know is BAD
but here is the thing, she had the exact same blood work done on her right before she fell (on 8/20) and the number was still too high, but it was 9.4,
so in the course of three weeks that number has risen by over three points.
Here are my questions for you guys and in advance want to say thank you for any advice/insight you could offer me to understand what was/is going on here.
Is there ever any sort of insulin regiment that runs on only novalog that is not a pump related treatment?
or in other words what was the doc thinking in putting that note in chart saying no long lasting insulin is to be given to her.?
Couldn’t the increase in the HgbA1c from 9.4 to 12.6 be directly attributed to her new insulin regime of novalog only,? and either way isn’t it a baromoter on the quality of care she is getting by both the home and especially the doctor?
Guys in advance I thank you from the bottom of my heart for any insight you can offer.