Re: Noncompliant diabetic....

[Nathan Lake]

The trend in the past few years has been to teach children and adolescents with diabetes a system of self-care that reflects what your resident is saying. Experience has shown that dietary restriction for people with diabetes, expecially kids, leads to cheating and poor blood sugar control. Therefore, the philosophy is to allow them to eat what they want and then teach them to cover their intake with a variable insulin scheme. This is not just a sliding scale, but a calculation based upon calorie intake. This scheme requires a higher level of understanding than the old fixed calorie diets required, but results in a higher level of compliance once they have that understanding.   We might consider a similar system for our elderly residents as well. Unfortunately, some will argue that this becomes a burden on the staff. If the resident's family decides to bring in chocolate chip cookies for the resident, the staff must be able to provide coverage at the time the cookies are eaten. This does not fit into the our typical, regimented medication administration schedule.   Nathan ----- Original Message ----- From: June Brunelle To: [EMAIL PROTECTED] Sent: Sunday, April 18, 2004 4:06 AM Subject: Re: Noncompliant diabetic.... I've always had a problem with the word  noncompliance since I had a resident who said she thought she could eat anything she wanted as long as she was covered by medication.  I've been doing the education thing, and making sure it is well documented(resident response,outcome) Education can be a part of the skilled process.   When one of my residents said I don't care, I'm going to eat the candy anyway, then I care planned her as noncompliant. June ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, April 16, 2004 9:37 PM Subject: Noncompliant diabetic.... Resident had hospital stay and upon return was covered for presumption of care.  After the 5-days we continued to cover this resident for very unstable blood sugars.  We are continuing to skill her due to many physician order changes and fluctuating blood sugars.  The problem with this resident is that she is free to leave her floor of residence and often is downstairs at the vending machines, thus abusing those blood sugars.  Is it OK to continue to skill this person or does the noncompliant behavior nullify Medicare?  I was going on the thought that she could not manage her care at home, without skilled care.  At least we constantly monitor so I felt the coverage was justified.