Q: My mother, who is a "brittle diabetic," has been sent to a skilled nursing facility for two weeks of rehabilitation following a seven-week hospital stay. I am amazed and frightened at the lack of concern for and attention to her diabetes care at the nursing home.

Despite our repeated requests for a diabetic diet, she continues to receive regular food trays. Often her insulin shots are missed. Her blood sugar has ranged between the mid-500s to as low as 38. Finally, one morning after her blood sugar dropped below fifty, I put her monitor and some snacks by her bedside so that she can at least partially manage her diabetes by herself.

Is there anyone out there to whom I can report this poor care? I've tried nurses, doctors, and patient care technicians, but no one seems to take this disease seriously. I'm afraid they're going to kill her.

Sincerely,
Ruth Wright

A: Dear Ruth,

Your mother's blood sugar control during her hospitalization is possibly being affected by a number of factors, including the stress response and the use of pharmacological agents, as well as the hospital's practices. To address your concerns about your mother's poor glycemic control, you could do the following:

• Request a diabetes consult to review and revise your mother's current diabetes plan.
• Schedule an appointment with the facility's nurse manager or director of nursing to discuss the issues impeding glycemic control, such as skipped insulin doses and the lack of a carbohydrate-controlled meal plan.
• Contact your local or state Long Term Care Ombudsman Program (at www.ltcombudsman.org). The federal Older Americans Act requires every state to create an ombudsman program to investigate and resolve complaints made by or on behalf of residents of long-term care facilities.

Mary M. Sullivan RN, APRN, BC, CDE
Diabetes Clinical Nurse Specialist/Nurse Practitioner