Table 1.

Challenges facing diabetes management at long-term care facility from American Diabetes Association guidelines^{50 128}

Patient related	Facility related	Diabetes management related
Irregular eating habits	Staff turnover	Sole use of sliding scale insulin
Altered cognition, anxiety and depression	Lack of nutritional individualization	Mismatch insulin administration timing in relation to feeding time
Impaired mobility	Lack of or insufficient glucose monitoring	Inappropriate hypoglycemia management
Polypharmacy and medication reconciliation errors	Limited staff diabetes-specific knowledge and training	Limited knowledge of advanced technologies (continuous glucose monitoring)
Variable levels of social support	Lack of pharmacist and dietitian support	Lack of comprehensive transitional diabetes management protocol
Variable nutritional needs	Lack of comprehensive notification system	Lack of diabetes management protocols
Persistent pain
Oral health, skin and vision problems