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By Julie Stefanski RDN, CDCES

According to the American Diabetes Association over a quarter of adults over age 65 have diabetes.

The average medical care for these individuals is 2.3 times higher than those who don’t have diabetes. (1) One analysis even found that 61% of all health care costs associated with diabetes were utilized on those individuals over age 65.2. (2)

Helping your resident improve their A1C is not only better healthcare, it’s better business. We often think of poor wound healing as the main result of uncontrolled diabetes, but the reach of insufficient glycemic control goes far beyond skin health.

Poorly controlled blood sugars increase risk of falls.

Diabetes has been found to be an independent risk factor for falls. Hypoglycemia may present as a cognitive sign. It’s more likely that an older resident will present with confusion, delirium and dizziness as a sign of hypoglycemia than the sweating or shakiness seen in younger individuals.3 Residents with diabetes may not recognize a low blood sugar or be able to communicate the feeling to staff.

In areas of preventative care, balance training has been shown to help improve reaction time and postural sway in older adults with type 2 diabetes (T2D).4

Glycemic control can impact cognitive function.

The desired target A1c for younger adults is <6%, but the ideal range for older adults is not so clear. Studies have shown that mental capacity can be impacted by blood sugar levels. In one study which measured cognitive abilities using scores on the Mini-Mental State Examination (MMSE), participants had better scores when A1c levels were 6-8%, versus those less than 6% or greater than 8%. Residents with new changes in cognition should be screened for diabetes.

Significant blood sugar issues often occur during care transitions.

Review specific diabetes management strategies any time a resident has been admitted from another care setting. Changes in appetite, acute illness severity, and the addition or discontinuation of important medications can lead to blood sugar levels below or above the desired therapeutic range. Conduct a review of current medications for changes, possible drug-drug interactions, and dosing adjustments. This can help decrease the likelihood of a serious blood sugar issue.

Adjustments to Insulin regimens can improve outcomes.

In 2016, the American Diabetes Association released its first position statement focused on care of those with diabetes in long-term care and skilled nursing facilities. ADA echoed other authorities in stating that the continued use of sliding-scale insulin dosing is behind the times when it comes to effective blood sugar management.3 Working to personalize a resident’s diabetes management plan is paramount to improving blood sugar levels. Try adding a bolus-basal insulin regimen based on food intake and blood sugars before meals. This can help modernize care for your residents. It also can improve both the lows and highs of their diabetes care and risk of future complications.

With the continued increase in the number of residents with diabetes it’s important to improve care of these individuals. Blood sugar control is vital to prevent not only the obvious complications that come to mind when we think of caring for an individual with diabetes.

Julie Stefanski MEd, RDN, CSSD, LDN, CDCES own a private nutrition practice in York, PA and has been a certified diabetes educator for more than 15 years.


  1. American Diabetes Association. ADA Website. Statistics About Diabetes. Updated March 22, 2018. Accessed November 11, 2019.
  2. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018; 41(5):917-928.
  3. Munshi MN, Florez H, Huang ES, et al. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association. Diabetes Care. 2016; 39(2):308-18. doi: 10.2337/dc15-2512.
  4. Morrison S, Simmons R, Colberg SR, Parson HK, Vinik AI. Supervised Balance Training and Wii Fit-Based Exercises Lower Falls Risk in Older Adults With Type 2 Diabetes. J Am Med Dir Assoc. 2018; 19(2):185.e7-185.e13. doi: 10.1016/j.jamda.2017.11.004.


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