Too often, Type 1 diabetes is pigeonholed as a “childhood” disease, a designation that leaves many adults with Type 1 without the support they need to manage the condition. However, as the average lifespan of people with Type 1 continues to lengthen, there will be more of a need for research into how to best care for a greying population of people with Type 1.
This can prove challenging, as there have been several studies showing that there is greater risk for hypoglycemia and diabetic ketoacidosis for people with Type 1 in hospital settings. This may be because a hospital stay often means disrupted routines and a break in the continuity of care, two elements that are often essential for the health of people with Type 1 diabetes.
A recent Leipzig University study provided a snapshot of some of the pitfalls of Type 1 diabetes care in a nursing home setting. According to a Healio report, researchers examined 405 cases of severe hypoglycemia that occurred to 205 nursing home residents over a seven-year period. The researchers found that those residents who needed active nursing care were 4.88 times more likely to experience severe hypoglycemia than a control group of people with Type 1 treated at an outpatient diabetes center. In the study, the need for daily nursing care was the biggest risk factor for experiencing a bout of hypoglycemia. Other risk factors included use of NPH intermediate-acting insulin and impaired hypoglycemia awareness.
(The report did not provide details of the age of the residents studied, or why they needed nursing care. Some who live in nursing homes are not there because of age-related impairments.)
Interestingly, the researchers found that those with depression were somewhat less likely to experience severe hypoglycemia than the control group. In fact, depression slightly edged out insulin pump usage as the greatest protective factor for avoiding hypoglycemia. This runs against other research which found that depression could be a key risk factor for severe hypoglycemia in people with Type 1.
Such results are a good reminder, however, to be proactive in your Type 1 management when under a nurse’s care in a hospital-like setting, or to make sure someone can be proactive in Type 1 management for you. Unfortunately, not every nurse or doctor is trained well enough in blood sugar management to keep all people with Type 1 safe in institutional medical settings.
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