Concerns Over Nursing Home Care: Uncontrolled Diabetes and High Blood Sugar Levels

Blood glucose levels have been consistently around 300 for a month in a patient with diabetes?

My mother was admitted to a nursing home on April 21, 2013.
I informed the nursing home that my mother has diabetes and that her blood sugar levels needed to be monitored.
The nursing home only checked her blood sugar levels once a week, and each time it was around 300.
This continued for a month.
The day before she was sent to the hospital, her blood sugar level was 393.
The next day (April 18, 2013), she developed a fever and became unconscious, leading to her hospitalization, where her blood sugar level was found to be 617.
They checked her blood sugar levels once a week, with the last reading being 393, and the nursing home did not communicate with the family or send her to the hospital.
Is there any negligence on the part of the nursing home? Dr.
Liao, my mother's name is Wu xxx.
She was previously hospitalized at Changhua Hospital, and I believe you were her attending physician.
I am now filing a lawsuit against the nursing home, and I would like to ask if you could help me by explaining some medical issues.

Wu Xiansheng, 50~59 year old female. Ask Date: 2015/05/16

Dr. Liao Zhongxin reply Internal Medicine

Dear Mr.
Wu,
1.
Your mother has been hospitalized in our facility three times: (1) May 2013, (2) July 2013, and (3) from June to July 2014.
2.
She has a history of old cerebrovascular accident with bed rest, diabetes mellitus, and hypertension.
During her hospitalization, her blood sugar was managed with insulin (20 units before breakfast and 16 units before dinner).
Additionally, she underwent blood glucose testing twice a day.
P.S.
If there are any further questions, please contact her attending physician, Dr.
Jiang Ya-Hui.
Thank you!

Reply Date: 2015/05/16

More Info

The situation you described regarding your mother's care in the nursing home raises significant concerns about the management of her diabetes and the responsibilities of the nursing facility. Based on the information provided, it appears that there may have been a lack of adequate monitoring and response to her elevated blood sugar levels, which could be considered a breach of care.

Firstly, diabetes management is crucial, especially for patients with a history of high blood sugar levels. The American Diabetes Association recommends regular monitoring of blood glucose levels, particularly for individuals with known diabetes. In your mother's case, her blood sugar levels were consistently high, averaging around 300 mg/dL, and peaked at 617 mg/dL before she was hospitalized. Such levels indicate poor glycemic control, which can lead to severe complications, including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and even coma.

The nursing home’s protocol of checking blood sugar only once a week is concerning, especially given your mother's known diabetes. Typically, patients with diabetes should have their blood glucose monitored more frequently, especially if they are on insulin therapy or if their blood sugar levels are not well controlled. The standard practice would involve daily monitoring, particularly for patients who have a history of fluctuating blood sugar levels or those who are newly diagnosed.

Moreover, the nursing home’s failure to communicate with the family regarding your mother's deteriorating condition is alarming. Effective communication is a critical component of patient care, especially when there are significant changes in a patient's health status. The nursing home should have informed you of the consistently high blood sugar readings and the potential risks associated with such levels. Additionally, they should have taken appropriate action, such as contacting a physician or transferring her to a hospital for further evaluation and treatment.

In terms of legal considerations, if you believe that the nursing home did not meet the standard of care expected in managing your mother's diabetes, you may have grounds for a complaint or legal action. It would be advisable to consult with a legal professional who specializes in medical malpractice or elder law to discuss the specifics of your case and explore your options.

Regarding your inquiry about Dr. 廖 and whether he can assist you, it would be beneficial to have a discussion with him about your mother's medical history and the care she received at the nursing home. He can provide insights into the medical aspects of her condition and the appropriate standards of care for diabetes management.

In summary, the nursing home appears to have fallen short in its duty to monitor and manage your mother's diabetes effectively. The combination of infrequent blood sugar checks, lack of communication, and failure to act on critical health indicators raises serious concerns about the quality of care provided. It is essential to address these issues not only for your mother's sake but also to ensure that other residents receive the appropriate care they deserve.

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