TABLE 1

Clinical Challenges and Strategies for Diabetes Care in LTC Settings (3)

Comorbidity/Geriatric SyndromeConsequencesManagement Strategies
Delirium or progressive cognitive decline• Irregular meal intake• Simplified medication regimen
• Refusal of glucose monitoring• Block glucose testing
• Refusal of medications or injections• Deintensification of treatment
• Avoidance of hypoglycemia
• Regular diet, preferred foods
Frailty and/or decreased mobility• Deconditioning• Optimized activity (seated, pedaling)
• Pressure ulcers• Repositioning if mobility is impaired, to avoid pressure ulcers
• Required assistance with feeding and toileting• Assessment and treatment of pressure ulcers
• Falls• Nutrition consultation
• Physical and occupational therapy
Depression• Weight loss or gain• Physical and social activities
• Refusal of activities and glucose monitoring• Psychological counseling
• Assess and treat depression
Skin infections, foot problems, nonhealing ulcers• Hyperglycemia• Increased glucose monitoring
• Poor intake, weight loss• Increased diabetes medications
• Impaired mobility• Nutrition consultation
• Regular skin checks and foot exams