Building Competency in Diabetes Education THE ESSENTIALS

4-44 | CHAPTER 4

Table 10: Strategies for cognitive dysfunction Affected Behaviour Impact on self-care

Strategies

Memory loss

Forget to monitor

Decrease monitoring times

•

•

CGM, Flash technology

•

Forget to take meds

Simplify, trigger, long-acting meds, reminders – phones, etc., pill box

•

•

Problem solving

Remembers but difficulty integrating into practice

Reinforce education

•

•

Small changes: support

•

Hypoglycemia unawareness

Avoid labelling ‘noncompliant’

•

•

Target tech.

•

Difficulty starting new behaviours Difficulty with mental flexibility

Appears ‘stubborn’

Avoid change; caregiver

•

•

Anxious – failure

Avoid sliding scales

•

•

Too much focus on SM

Simplify

•

•

Adapted from Munshi 2017 (93)

Managing diabetes in the long-term care facility It is estimated that one out of four residents in long-term care (LTC) facilities in Canada has type 2 diabetes (108). As people are living longer with type 1 diabetes, we are also seeing an increasing number of these patients in LTC. With the complex care often required due to multiple co-morbidities, it is necessary to simplify the tasks related to diabetes management (91,109). Two areas of specific concern related to medications and nutrition have been identified and recommendations have been made: • “Regular diets” may be used in nursing homes instead of “diabetic diets” or “diabetic nutritional formulas” to avoid undernutrition. • Deprescribing of antihyperglycemic medications contributing to hypoglycemia should be considered, i.e. OHA for insulin in type 2 diabetes • Simplify insulin regimens, eliminating the use of sliding scales and correction doses (3,72,81).