Diabetes is a challenging disease, but it can be managed by faithfully following lifestyle guidelines. People with diabetes do have a lot to balance; as they get older, following through on these guidelines may require assistance from a caregiver. Here's what you need to know.
- It all starts with food. What we eat, how we eat it and who we eat with—this is a basic part of socialization, which is extremely important for those who are losing or have lost their ability to care for themselves, along with choosing and preparing food. A caregiver should have a long talk and listen carefully to what their parent says about their likes, dislikes, portion sizes and so on. Then go from there.
- Help your parent enjoy some of what they really like. From the standpoint of a dietitian, I would stress the importance of eating regular meals at regular times, including snacks as needed. Having protein with all meals and snacks and adequate carbs (topics of a future article), all play a role. I would also stress that just "not eating sugar" is NOT what constitutes a well-balanced meal plan. We are way beyond that and, in fact, some sugar can be included. The huge market of "sugar free foods" makes me crazy! With only rare exception, ALL of those foods still contain significant amounts of carbs and WILL raise blood sugar. I usually suggest a small scoop of ice cream (1/4 to 1/2 cup) or a good quality cookie (smallish) or a very small piece of pie or cake. Who wants to give up the "good things" in life because they have diabetes?!
- Blood sugar testing is key when Mom or Dad is on insulin. Caregivers should be taught by a diabetes educator how to test. No, it is not rocket science, but technique is very important. The meters are generally available for free from most companies (they make their money on the strips and ongoing supplies). All of the meters on the market are pretty good. All require a finger stick even though some of the ads imply that they do not (quite a disservice to the diabetes public). Meters should be replaced every one to three years—Medicare and other private insurers have their own rules on that. Using a meter older than two or three years may mean inaccurate readings, even if the technique is done well. Strips can become outdated or ruined by exposure to heat or humidity, so take care to check them. Since the patient's MD can call in an order for meter, strips, supplies to a local or mail-order pharmacy and renew prescriptions periodically, that part is easy! Folks on insulin often need to test before meals and sometimes after to make sure the dose is correct. It is not unusual for people on insulin to test 6 to 8 times a day—hopefully not everyone, but it all depends on the individual.
- Blood sugar testing is vital for non-insulin taking patients, too. They need to properly do blood sugar testing within 15 to 30 minutes of waking up. Normal Fasting Blood Sugars (FBS) should be below 100, in some cases perhaps up to 120 depending on the MD. There is some thought that as we age the range of normal should go up. I don't think there is a fast rule, but most docs would likely say an 80 year old with an FBS of 121 is just fine. There is more of an issue of blood sugars being too low causing more problems than too high. Other testing times would be two hours after meals—normal would be less than 140 (in some cases, less than 160.) There are two or three major medical associations that all have different opinions on the levels of blood sugar—it does not make it easy for the consumer! For folks in fairly good control, probably testing FBS and 2 hours after a meal twice a week is enough! If folks are struggling with highs and/or lows, testing 2 hours after each meal will start to solve the problem as we can see what foods or meals are causing the problem (or the need for more or different meds). For folks in good control I often suggest this pattern for one to two weeks: FBS daily PLUS two hours after breakfast on Day One; two hours after lunch on Day Two, and two hours after dinner on Day Three, then repeat the pattern. That way a person is only testing twice a day, but you can glean a clearer picture as to any possible trouble spots.
- Persuade your parent to take all necessary steps for prevention. Medical visits are numerous and time-consuming, but vital. The visits suggested in the list below are all part of diabetes care and may ensure a better quality of like. Much of it means a trek to an office or lab, but that whole deal can be a part of an outing—maybe go for lunch after the appointment.
- Primary care MD (PCP)—the one to call for unexpected issues and the one who will direct referrals for other issues: usually four times a year
- Cardiologist: usually once or twice a year, depending on heart health
- Endocrinologist—the diabetes specialist: one to four times a year
- Dentist: usually once to twice a year
- Podiatrist: can vary from every 6 weeks to one or two times a year, depending on foot problems and preventative foot care needs
- Ophthalmologist: at least once a year
- Other specialists who may come along with other problems, maybe a nephrologist (for the kidneys) or neurologist (if there are nerve issues, pain in the feet and the like)
- Lab tests: probably done 2 to 6 times a year, depending on other complications that one may be dealing with
Very important: The caregiver should have a list of ALL meds and supplements that Mom or Dad takes—dose, times per day, etc. and keep it updated. Also the caregiver should ALWAYS go to the appointments and sit in with the MD and the patient. That way there is no question as to what the doctor said or did not say, and other issues may come to light that the patient may not think of.
Help Mom and Dad maintain hobbies and interests. Encourage them to go social events and meetings of clubs they belong to, if at all possible. Keep that mind active and increase socialization. On occasion a parent participating in an activity may give the caregiver a break!
Get up to speed on the business of the elder's life. Caregivers will likely need to participate in bill paying, banking, mail, errands. You need to get familiar with how your loved one's life runs.
Consider joining The American Diabetes Association for your sake as well as theirs. Not only is it THE national organization for education and research surrounding diabetes, but when you join you get a monthly subscription to Diabetes Forecast Magazine which is one of the best…It is written for people who have diabetes and keeps us all up to date with new products, services and medical advancements as well as answering ongoing questions. I call it the People Magazine for person with diabetes. Another good point and one that makes my teeth grind: People are NOT diabetics. They are persons who have diabetes—a very important distinction!!!!
Make sure all wills and Advanced Directives are up to date and current with the wishes of your parent. Go to the "Legal Ease" in the Parentgiving Learning Center for details. This is crucial, even if your parent is in excellent health today. You don't want to have to first address these issues in a crisis.
Look for ways to insure some safe and appropriate exercise, even for chair-bound persons. (Exercise should be done AFTER meals, and not before.) At this point the caregiver becomes the "coach." Yes, another role, another vital role.
Joy K. Richardson, RD, CDE, has been a Registered Dietitian for over 35 years and a Certified Diabetes Educator more than 20 years. She has worked in clinics and outpatient education programs as well as private practice. Joy's career path was inspired by family members battling the disease, starting with her grandmother who lived with it for over forty years until she was in her late —80s. Look for Joy's diabetes forum launching soon on parentgiving.com.