It was Jim’s* fourth trip to the ER in less than two months: blood glucose levels of 400+, diabetic ketoacidosis, treatment, and discharge. At age 75, Jim was riding the ‘rollercoaster of health care crises,’ and his health was only getting worse. Fortunately, a case manager at the Alta View Hospital emergency room became concerned about his frequent visits and his resistance to following directions, prompting her to contact Homespire, an Intermountain Healthcare company, to make a service introduction.
Jim wasn’t keen on having a consultation with the Homespire nurse but given that it would be at no cost to him, he reluctantly agreed. Another factor: his adult daughter and his significant other, Kassie, were at their wits’ end and desperate for outside help.
Discovery and education
When Allison Godwin, RN, Homespire Nurse Care Manager arrived at Jim’s home on March 1, she was struck by how fragile he looked. “His body was stooped, he walked with a shuffle, and he seemed confused,” she said. After initial introductions, she discovered that her client had no idea about the ramifications of high blood sugar. He admitted he was frustrated and depressed that diabetes was allowed to rule his life, and as a result, he wasn’t checking his blood sugars, taking his meds, or going to his follow-up appointments. “From Jim’s perspective, diabetes was an annoying, inconvenient ordeal.”
Allison realized that she needed to start with education, not just for Jim, but also for Kassie and Jim’s daughter. “Unless everyone understood what was at stake and what it was going to take to control his diabetes, nothing would change.” She explained the basics of Type 2 diabetes, the risks of uncontrolled blood sugars, including a life-threatening condition called diabetic ketoacidosis (DKA), the role of insulin, and why it was so important that Jim check his blood sugars before eating.
Allison also called Jim’s primary care clinic and learned that he had missed multiple appointments. She scheduled one for the following week, but in the meantime, she needed to sort out his medications to keep him out of the ER. “There were so many discrepancies between the sliding scale that the clinic read to me, the recommended dosage, and the actual drug dose,” she said. “That’s when I realized his doctor had ordered the wrong insulin dose.”
After doing some math, Allison created a simple ledger with clear instructions for Jim and Kassie. “I told him to check his blood sugars every day before breakfast and also before lunch, and that if the number was 150, to take this amount, and if it was over 250, to take that amount,” she explained. “I had him dose his insulin right there so I could coach him and Kassie.”
Allison took over setting up his medications. He’d been missing many of his doses, so she came up with a strategy to help him stay on task: The pillbox of morning meds goes next to the coffee maker and the pillbox of nighttime meds goes on the nightstand.
She also suggested placing cheap, over-the-counter blood glucose monitors in several places throughout his house so he wouldn’t need to carry around the bulky blood glucose monitor. The game changer for Jim was when Allison talked to him about ordering a continuous monitor that would measure his blood sugars automatically. “His eyes lit up!” she said.
The consultation lasted a full four hours, but before they were even partway through, Kassie told Allison, “You’ve already proven your worth!” The couple wanted to continue working with their Nurse Care Manager on a weekly basis. According to Allison, each time she visits with them, Kassie tells her, “You are priceless!”
Client advocacy in action
The following week, Allison, Jim, and Kassie met with his primary care physician who was resistant to the information she offered. More importantly, he refused to believe that he’d prescribed the wrong dosage . Finally, however, he came around and even helped Jim get an endocrinology appointment much sooner.
When they met with the endocrinologist two weeks later, Jim’s blood sugars were in the 150 range but there was still room for improvement. “This doctor was amazing—he listened, asked questions, and immediately applied a continuous monitor to Jim’s arm” Allison said. “He also prescribed a new oral hypoglycemic with fewer side effects.” With her help, the endocrinologist discontinued medications that weren’t helping and, in fact, may have destroyed Jim’s pancreas.
New zeal for life
The couple has taken an active interest in Jim’s health. Kassie continues to text his blood sugars to Allison, and when they were out of town, they met weekly on Facetime. “Kassie told me that her first husband died of a chronic illness and that before I came into the picture, she was on the brink of leaving Jim,” Allison said. “Now, he’s practically a new man!” He answers the door with energy, he and Kassie go out every day, and they even traveled to Colorado together. “I filled five weeks of pillboxes so they wouldn’t have to worry,” she said. “He’s got a zeal to life that didn’t seem possible six weeks ago!”
To learn how Homespire can help your loved one live a healthier, happier, more independent life, schedule your free consultation today.
*Names have been changed to protect client privacy.