Diabetes Care in Nursing Homes: Best Practices and Considerations

Understanding the Challenges of Diabetes Management in Care Settings

Diabetes management presents unique challenges in nursing home environments. With approximately 25% of nursing home residents living with diabetes, effective care approaches are essential for maintaining quality of life, preventing complications, and supporting overall health and wellbeing.

This guide explores the complexities of diabetes care in nursing home settings, highlighting best practices for care providers, and considerations for families of residents with diabetes.

The Prevalence and Impact of Diabetes in Nursing Homes

Diabetes is significantly more common in nursing home populations than among older adults living in the community. This high prevalence brings several important implications:

Complex Care Needs

Older adults with diabetes in nursing homes typically have more complex health profiles than their counterparts in the community. Many experience:

• Multiple co-existing health conditions (comorbidities)
• Cognitive impairment or dementia
• Limited mobility affecting exercise options
• Polypharmacy (multiple medications)
• Varying levels of ability to participate in self-management

These complexities require carefully individualised care approaches that balance diabetes management with quality of life considerations and management of other health conditions. Understanding what is nursing care in broader terms helps contextualise how diabetes management fits within comprehensive care delivery.

Higher Risk of Complications

Nursing home residents with diabetes face elevated risks of both acute and chronic complications:

Acute complications include hypoglycaemia (low blood sugar), which can cause confusion, falls, or more serious medical emergencies. Chronic complications such as cardiovascular disease, kidney problems, vision impairment, and foot ulcers may progress more rapidly without proper management.

These risks make vigilant monitoring and proactive care essential components of nursing home diabetes management. The importance of nursing care plans becomes particularly evident when managing complex conditions like diabetes, where coordinated approaches prevent serious complications.

Individualised Care Planning for Diabetes in Nursing Homes

Assessment and Goal Setting

Effective diabetes care in nursing homes like Lowmoor begins with comprehensive assessment and realistic goal setting:

Each resident with diabetes should receive a thorough initial assessment covering:

• Diabetes history, including previous management approaches
• Current physical and cognitive function
• Nutritional status and preferences
• Ability to recognise and report symptoms
• Risk factors for complications
• Life expectancy and quality of life considerations
• Resident and family preferences regarding care intensity

Unlike diabetes management in younger populations, where tight blood glucose control is typically the primary goal, nursing home diabetes care often focuses on preventing symptomatic hyper- and hypoglycaemia while avoiding overly restrictive regimens that might reduce quality of life.

Tailored Blood Glucose Targets

The American Diabetes Association and other authorities recommend less stringent blood glucose targets for frail older adults in nursing homes compared to younger, healthier individuals:

• For relatively healthy older adults with longer life expectancy, HbA1c targets of 53-58 mmol/mol (7.0-7.5%) may be appropriate
• For those with moderate complications or cognitive impairment, HbA1c targets of 58-64 mmol/mol (7.5-8.0%) are often recommended
• For those with multiple serious health conditions, significant cognitive impairment, or limited life expectancy, even less stringent targets of 64-70 mmol/mol (8.0-8.5%) may be suitable

These more relaxed targets reflect the increased risks of hypoglycaemia in older adults and the diminished benefits of very tight control in those with limited life expectancy.

Individualised Care Plans

Each resident’s diabetes care plan should be tailored to their specific needs, considering:

• Cognitive status and ability to participate in care
• Physical capabilities and limitations
• Nutritional needs and preferences
• Overall prognosis and care goals
• Coexisting medical conditions
• Quality of life priorities

These plans should be documented clearly, regularly reviewed, and adjusted as the resident’s condition changes. This approach aligns with the principles outlined in our guide to what is person-centred care, which emphasises care that respects individual preferences and needs.

Key Components of Nursing Home Diabetes Management

Blood Glucose Monitoring

Blood glucose monitoring in nursing homes requires thoughtful protocols:

For residents on insulin, regular monitoring is essential, with frequency determined by individual factors including insulin regimen, stability of glucose levels, and risk of hypoglycaemia. For those on non-insulin medications with lower hypoglycaemia risk, less frequent monitoring may be appropriate.

Staff should be trained to recognise signs of high or low blood glucose, particularly in residents who cannot effectively communicate symptoms. This includes understanding that confusion, agitation, or behavioural changes may indicate blood glucose abnormalities rather than psychiatric issues.

Medication Management

Medication approaches for diabetes in nursing homes often differ from community settings:

Insulin Administration

For residents requiring insulin:

• Simpler regimens with fewer daily injections are often preferred
• Long-acting basal insulins may be favoured for their lower hypoglycaemia risk
• Sliding scale insulin regimens (adjusting doses based on blood glucose readings) should be used cautiously due to hypoglycaemia risks
• Pre-mixed insulin formulations may simplify administration for some residents

Oral Medications

When selecting oral diabetes medications, the burden should be considered, favouring once-daily options where appropriate

Nutrition Management

Nutritional approaches for nursing home residents with diabetes should balance control with quality of life:

The strict “diabetic diets” of the past have largely been replaced by more flexible approaches that focus on portion control, regular meal timing, and consistent carbohydrate intake rather than severe restrictions.

Residents should have input into menu choices where possible, and inflexible dietary restrictions that negatively impact food enjoyment or nutritional intake should be avoided. Malnutrition poses a greater risk to many nursing home residents than suboptimal blood glucose control.

For residents with inadequate oral intake, nutritional supplements may be necessary even if they contain sugar, with medication adjustments made to accommodate these additions rather than withholding needed nutrition. Our insight into the mealtime experience in care homes further explores how quality nutrition contributes to overall wellbeing.

Physical Activity Considerations

Even limited movement provides benefits for residents with diabetes:

• Chair-based exercises can improve circulation and help with blood glucose management
• Range of motion activities help maintain joint function
• Scheduled position changes for bed-bound residents prevent pressure injuries
• Physiotherapy input can help design appropriate activity plans for those with mobility limitations

Our article on the importance of activities in nursing homes discusses how carefully planned physical and social activities contribute to both physical health and emotional wellbeing.

Foot Care and Wound Prevention

Proactive foot care is essential for preventing serious complications:

Nursing home residents with diabetes should receive regular foot inspections, proper nail care, appropriate footwear, and prompt attention to any skin breakdown or injuries. Staff should be trained to identify early signs of foot problems, and protocols should be in place for rapid escalation of concerns to prevent serious complications.

For residents with existing foot ulcers or wounds, specialised care plans including pressure relief, appropriate dressings, and infection monitoring are essential.

Management of Diabetes Complications in Nursing Homes

Hypoglycaemia Prevention and Management

Preventing and promptly treating low blood glucose is a priority:

Hypoglycaemia poses significant risks for nursing home residents, including falls, cognitive decline, cardiovascular events, and reduced quality of life. Prevention strategies include:

• Appropriate medication selection and dosing
• Regular and consistent meal timing
• Blood glucose monitoring protocols
• Staff education about risk factors and early signs
• Care plan adjustments when patterns of hypoglycaemia emerge

All nursing homes should have clear protocols for treating hypoglycaemia, including access to fast-acting glucose sources and glucagon for emergencies. Staff should be trained in these protocols and documentation of all hypoglycaemic episodes should inform ongoing care planning.

Skin and Wound Care

Proactive approaches to skin integrity help prevent serious complications:

Residents with diabetes have increased risk of skin breakdown and delayed wound healing. Nursing homes should implement:

• Regular skin inspections, especially of feet and pressure points
• Proper positioning and turning schedules
• Appropriate pressure-relieving surfaces and devices
• Moisture management for fragile skin
• Nutritional support for wound healing
• Prompt treatment of any skin breakdown or injuries

Our guide to fall prevention in care homes provides additional insights into creating safer environments for residents with mobility and balance challenges, which often accompany diabetes.

Managing Cognitive Impairment Alongside Diabetes

The intersection of diabetes and dementia requires specialised approaches:

For residents with both diabetes and cognitive impairment:

• Simplified medication regimens reduce risk of errors
• Visual cues may help with meal timing and other routines
• Behaviours like refusing food may reflect fear of injections rather than appetite loss
• Blood glucose targets may need adjustment to prioritise safety and comfort
• Staff should be attentive to non-verbal signs of hypoglycaemia or hyperglycaemia

Understanding how to effectively connect with care home residents who have dementia is particularly important when managing conditions like diabetes that require consistent monitoring and care.

Staff Training and Competencies

Essential Knowledge and Skills

Nursing home staff caring for residents with diabetes need specific competencies:

All care staff should understand:

• Basics of diabetes pathophysiology and management
• Signs and symptoms of hyper- and hypoglycaemia
• Proper blood glucose monitoring techniques
• Appropriate insulin administration
• Foot and skin assessment skills
• Nutritional considerations for diabetes
• When and how to escalate concerns

Regular updates on best practices and refresher training help maintain these skills, particularly for care homes with higher turnover rates.

Interdisciplinary Collaboration

Effective diabetes care in nursing homes requires teamwork:

The best outcomes come from collaboration between:

• Care staff providing daily support
• Nursing staff overseeing care plans
• Medical providers managing prescriptions and complex decisions
• Dietitians advising on nutritional approaches
• Podiatrists providing specialised foot care
• Pharmacists reviewing medication regimens
• Activity coordinators incorporating appropriate exercise
• The resident and their family in decision-making

Regular team meetings to discuss resident progress and challenges help ensure coordinated care approaches. This collaborative approach aligns with the fundamental standards of care that guide quality provision across all aspects of nursing home services.

Quality Assurance in Diabetes Care

Monitoring Quality Indicators

Nursing homes should track key diabetes care metrics:

Important quality indicators include:

• Frequency of hypoglycaemic episodes
• Hospital admissions related to diabetes complications
• Regular foot examinations completed
• Appropriate HbA1c monitoring
• Resident satisfaction with care approach
• Annual diabetes-specific care plan reviews
• Staff competency assessments

Regular audit of these indicators helps identify areas for improvement and track progress over time.

Policies and Procedures

Clear organisational guidelines support consistent care:

Nursing homes should have documented policies covering:

• Blood glucose monitoring protocols
• Insulin storage and administration
• Hypoglycaemia prevention and treatment
• Hyperglycaemia management
• Sick day protocols
• Diabetes medication management
• Foot care standards
• Meal planning approaches
• Staff training requirements
• Documentation standards

These policies should be regularly reviewed and updated to reflect current best practices and align with the 6 Cs of care: care, compassion, competence, communication, courage, and commitment.

Supporting Resident Autonomy and Quality of Life

Balancing Control with Quality of Life

Diabetes management should enhance, not detract from, wellbeing:

The most appropriate diabetes care approach for nursing home residents often differs from what might be recommended for younger individuals. Key considerations include:

• Avoiding overly restrictive diets that reduce food enjoyment
• Minimising painful procedures when benefits are limited
• Considering the resident’s wishes regarding care intensity
• Focusing on preventing symptomatic hyper- and hypoglycaemia rather than achieving “perfect” numbers
• Adjusting goals as conditions change or health declines

This balanced approach recognises that quality of remaining life may sometimes take precedence over maximising longevity through intensive management, reflecting principles outlined in our guide to maintaining independence in care homes.

Involving Residents and Families

Shared decision-making improves care satisfaction:

Residents who retain decision-making capacity should be actively involved in their diabetes care planning. For those with cognitive impairment, families or designated decision-makers should participate in discussions about care goals and approaches.

These conversations should include honest discussions about:

• The benefits and burdens of different management approaches
• Realistic expectations regarding outcomes
• Quality of life implications of care choices
• Preferences for management during acute illness or end-of-life stages

End-of-Life Considerations for Diabetes Care

Adapting Care During Palliative Stages

Diabetes management approaches should evolve during end-of-life care:

As residents enter palliative care stages, diabetes management typically shifts to focus exclusively on comfort and symptom management. This often involves:

• Discontinuing or simplifying blood glucose monitoring
• Stopping medications aimed at long-term complication prevention
• Maintaining only treatments necessary to prevent significant symptoms
• Eliminating dietary restrictions
• Treating hypoglycaemia but accepting higher glucose levels

These adjustments reflect the changing goals of care, recognising that comfort and dignity become the primary focus during end-of-life stages. For more information on comprehensive end-of-life support, see our guide on pay for palliative end-of-life care.

Person-Centred Diabetes Care in Nursing Homes

Effective diabetes management in nursing homes requires balancing medical best practices with quality of life considerations. By taking an individualised approach that considers each resident’s overall health status, preferences, and prognosis, nursing homes can provide diabetes care that supports wellbeing while minimising risks and burdens.

The most successful approaches recognise that diabetes is just one aspect of a resident’s health picture, and that care must be integrated with management of other conditions while preserving dignity, autonomy, and quality of life.

At Lidder Care, our nursing homes in Mansfield and Nottinghamshire incorporate these principles into individualised care for residents with diabetes. Our trained staff work closely with healthcare professionals to deliver diabetes care that is both medically appropriate and aligned with each resident’s personal preferences and overall wellbeing.

For more information about how we support residents with diabetes or other chronic health conditions, please contact our team on 01623 345 500.