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The Transition From Home to Skilled Nursing: the Patient With Type 1 Diabetes

May 17, 2016

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or whatever reason – which may or may not be related to their diabetes – many of our patients will need to transition from home or hospital, to skilled nursing care at some point in their lives. It may be for a short-term or an extended-period of time. The transition is often bumpy. A patient may have been on carbohydrate coverage, which is not recognized by the nursing home, or he/she may have been on an insulin pump which is no longer a viable option due to physical or mental disabilities. Or the patient may be suffering from chronic renal failure, requiring adjustments in insulin doses that have been a standard for multiple years.

As the challenges for self-care change – requiring more and more assistance – the supportive persons require education, not only about caring for someone with diabetes, but the variability of each and every person with diabetes and their blood glucose response to insulin and food.


Designing a program that is both safe and achievable in the assisted living environment is a challenge in which diabetes educators can and should play a vital role.


The diabetes educator can help in the transition by participating in education of the staff caring for persons with diabetes in home care and skilled nursing care facilities. It is important to be an advocate for our patients by discussing care not only with the providers, but the administrative staff as well. This may include the opportunity to talk with the kitchen staff and become involved in assessing carbohydrate counts of menu items.

Working with the primary care physicians (or hospitalists) in simplifying the insulin regimen may also help to minimize errors. For example, using fixed dose insulin for meals plus a correction scale for individuals who are predictable eaters may work. We need to recognize that standards of care no longer recommend the same A1C goal for persons as they age and develop multiple co-morbidities or lose the sensation of hypoglycemia. Designing a program that is both safe and achievable in the assisted living environment is a challenge in which diabetes educators can and should play a vital role.  

In the January issue of Diabetes Care, the ADA published their position statement on the Management of Diabetes in Long-term Care and Skilled Nursing Facilities. This is a helpful document for CDEs who have patients that are in this transition. In addition, the American Medical Directors Association guidelines also provide information that can be helpful in promoting best care for our patients in assisted living situations.  

As stated in the July/August 2013 issue of the Diabetes Educator, “Because diabetes assessment, care and education are concerns for many home health care patients, the need for credentialed educators to serve as resources for home care nurses and aides will likely increase. This need also extends to long-term care facilities.”

Share your experiences and suggestions for this population group which is growing yearly.


Carla CoxAbout the Author:

Carla Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 25 years, and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works in Missoula, Montana as a diabetes educator in both in- and outpatient settings.
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