Table 6

Specific situations needing attention in patients with diabetes in LTC setting

Recommendations for LTC staff for diabetes management*
Glucose meter reading <70 mg/dL and unresponsive• Treat hypoglycemia per protocol without any delay
Consecutive glucose meter readings <70 mg/dL• Call practitioner
• Confirm low glucose value by laboratory test
• Evaluate nutritional intake
• Consider an increase in frequency of glucose monitoring for 24 h
• Adjust diabetes regimen as needed
Glucose meter readings >250 mg/dL two or more times within 24-h period accompanied by a new or change in medical or functional status• Call practitioner
• Increase frequency of glucose monitoring
Glucose meter readings >300 mg/dL during all or part of 2 consecutive days• Confirm high glucose value by laboratory test
• Evaluate nutritional intake
Any glucose reading too high to measure by glucose meter• Adjust diabetes regimen as needed
• If glucose levels are persistently high after changes to the diabetes regimen, consider medical evaluation for other causes (i.e., infection)
Patient not eating, vomiting, or unable to take oral glucose-lowering medications• Call practitioner as soon as possible
• Consider insulin therapy and adjust dose accordingly based on nutritional status
  • * It is more important to address persistently abnormal trends in blood glucose values rather than attempting to adjust the treatment regimen in response to a few isolated abnormal values.