Whether you’re a family member to someone with diabetes or are a direct care worker, being a caregiver can get overwhelming fast. You may be juggling multiple visits to specialists, constantly taking inventory and restocking a long list of diabetes care supplies, checking lab work results online, or trying to follow their doctor’s insulin therapy protocol.

You may have many questions. Can they eat that piece of pie? What do you do when they feel dizzy?

Understand the disease

Caregivers should know things such as:

• The A1c levels of the older adult
• The older adult's other health conditions (or ‘comorbidities’)
• Symptoms and known complications
• Prescribed medications (Adhering to the older adult's medical care treatment is the cornerstone of optimal diabetes care management. Caregivers should strictly follow the doctor’s instructions.)
• Insulin protocols (Insulin therapy is the primary treatment approach for patients with type 1 diabetes and is sometimes used for type 2 diabetes, if the patient is unable to keep their blood sugar levels within a healthy range.)
• Schedule for routine check-ins with the primary care provider and/or specialists

Adopting a new diet and lifestyle

Diet is one of the primary ways medical providers encourage anyone with diabetes to keep their glucose levels in a healthy range. Healthy food choices can help to keep the blood glucose level within the target range.

Reluctance to switching to healthier alternatives is an expected reaction. One way to show support: get the whole family on board with the same dietary changes and new menus. 

For people with type 1 diabetes, lower carb diets can go a long way to reducing the number of sugar spikes and lows they experience throughout the day, any and all carbs need to be chased with some amount of insulin.  Every single morsel of food requires insulin; and hence, proper planning.

For both types of diabetes, you’ll quickly become accustomed to spotting which carbohydrates tend to spike blood glucose. Fruit like watermelon and bananas might be the culprit for some; for others, even alleged ‘sugar free’ foods or products with sugar substitutes may spike their sugar. 

Periodic health monitoring and A1c testing

Regular health checkups, including regular A1c testing with a lab, is part of the diabetes management program, making them highly relevant for any caregiver, too. Visit the doctor at the scheduled time, take note of the glucose readings, and follow other instructions.

An A1c test captures the patient’s blood glucose levels in the past three months. If A1c levels are on the high end, the medical provider may recommend testing every four months (or four times per year). Get comfortable with your local laboratory, their schedules, and the best time to come in for testing.

Caregivers should also monitor the older adult closely to see how well they respond to the treatment.

Comorbidities and the cocktail of medications

The term comorbidities refers to slew of other health conditions that accompany type 2 diabetes and may or may not relate to diabetes directly, such as asthma. Some of these conditions may have been present before diabetes diagnosis, while others may develop after. For example:

• Arthritis may have developed after the diabetes diagnosis, but is not presumed to be directly connected.
• Partial blindness can occur as a result of diabetes, but it may also have arisen due to other childhood conditions.

According to the American Diabetes Association (ADA), about 40% of adult diabetic patients have at least three or more comorbidities. Common comorbidities include hypertension, overweight/obesity, cardiovascular diseases, kidney complications, and other conditions.

Dealing with comorbidities is the toughest challenge for health care providers and family members. They must address these conditions alongside diabetes care, often juggling multiple medications and therapies for each.

Medications and care coordination

Addressing comorbidities with diabetes through comprehensive treatment and home care is critical to preventing coma and other life-threatening conditions. Special attention should be paid to the interaction between medications taken for each condition and to any new symptoms or side effects.

While coordination of care between providers is always the goal, our health care system is very complex. If you’re filling prescriptions at the same pharmacy (always recommended), ask to speak to the pharmacist to verify any potential interactions between newly prescribed medications. 

Too often, older adults are prescribed medication by a new specialist (be it, a nephrologist, neurologist, or other) or by an emergency care provider following a hospitalization. Yet, often no one stops to consider how the medications interact with each other.

Sometimes, the older adult may even end up with multiple prescriptions for medications intended to treat the same condition.  it’s always important to enquire about medications and pay close attention to side effects. Try to find out what the purpose of each medication, along with whether it is truly needed. 

Diabetes and mental health

Joining a diabetes support group can be beneficial for you and the older adult. Support groups help to decrease isolation, giving people the sense that others are in the same boat. 

The American Diabetes Association (ADA) is also tapped into Aunt Bertha’s extensive repository of community resources that you can search for just about anything, from help with transportation to accessing disability benefits and more.

Even more concerning is the intersection between diabetes and depression. In particular, having diabetes increases risk for depression, while being depressed increases your risk of type 2 diabetes and can make diabetes management more difficult.

Thankfully, diabetes and depression can be treated together, and some treatment approaches, like exercise and weight loss, can help both conditions at the same time.

If the person in your care is showing any symptoms of depression, including being overly pessimistic, it’s important to talk to their doctor about depression and treatment approaches. 

Mobility Issues

Physical disability and cognitive impairment are other known threats to the well-being of older adults with type 1 or type 2 diabetes, especially if there have been extended periods of poorly controlled diabetes. Studies have linked diabetes to increased likelihood of complications in neuropsychological functions, mobility syndromes, and partial or full disability. 

A decline in cognition can make it more difficult to perform basic tasks, such as dressing or walking independently.

Caregivers will need to be ready to accommodate somone's slow gait or have assistive devices on hand . You may need to opt for a scooter or even a wheelchair at the grocery store or mall, or bring your own seating if you anticipate long wait lines.

Blood Sugar Levels

Blood glucose testing is a well-known part of diabetes management.

The doctor may refer the patient to a lab for an A1c test (hemoglobin A1c/HbA1c) as many as four times per year, prior to a routine check-up or based on any apparent symptoms. Some providers have on-site testing capabilities, referred to as ‘point of care’ testing. The test shows the average blood sugar level in the body over the past three months. 

The readings from the A1c test reports clearly depict whether a person has prediabetes or diabetes. This is the first step in diabetes management. The A1c levels in the result help you determine what you need to do further.

The American Diabetes Association defines the levels like this, as do the NIDDK and CDC:

• Normal: Below 5.7%
• Prediabetes: 5.7% to 6.4%
• Diabetes: 6.5% or above

The guidelines are intended for the average adult. They can apply to older adults when they are otherwise healthy and functional, don’t have cognitive impairment, and are projected to have a decent life expectancy.

However, while most doctors recognize that A1c requirements may be relaxed for older adults who are dealing with multiple health conditions, such as hypertension (high blood pressure) and hyperlipidemia (high cholesterol).

How Often Should Levels Be Tested?

Once diagnosed with diabetes, adequate diabetes management aims to keep the blood glucose levels within the normal range. The physician will determine the frequency at which the person may require a test, depending on the severity of the condition.

The person in your care may need to check the readings with a glucometer at home at least once a day or even more, especially before and after a meal. Nowadays, it is easy to do so with a continuous glucose monitor (CGM) device to avoid pricking one’s fingers.  

Long-term risks of poorly controlled diabetes in older adults

Why is your help as a caregiver so vital?

For one thing, poorly controlled hyperglycemia has been linked to multiple comorbidities in seniors. Long-term diabetes can damage the vital organs and even lead to some severe life-threatening illnesses.

Diabetics aged 75 years or higher are at a greater risk compared to those in the age group of 65 to 74 years. With aging, prolonged history of diabetes can cause both vascular and non-vascular complications including peripheral neuropahty (nerve damage), myocardial infarction (heart attack), retinal diseases that can lead to a loss of vision, and vascular dementia.

Caregiver tools and resources to manage diabetes in older adults

Diabetes management is made easier with many modern tools and technologies. Some of tools and resources that can make the entire process less daunting:

1. Continuous glucose monitors

Blood glucose meters (or glucometers) used to be the go-to for checking glucose levels throughout the day, requiring one to pierce their finger with a lancet. Now a continuous glucose monitors (CGM) can be attached to the arm and provides a constant read on fluctuating blood glucose levels. Alarms can be programmed at various levels, such as to alert the user when their blood glucose is below 80 or when they are over 180 for an extended period of time. 

Caregivers can receive the glucose reading on their smartphone connected to the app that is paired to the CGM device. You can receive the signal at the grocery store or down the street and get an immediate alert if the senior in your care has a glucose level that is dropping fast.

2. Insulin Pens and Ultra-Fine Pen Needles

Every diabetic patient wishes to have pain-free insulin injections. The newest insulin pens have the option to be used with ultra-fine pen needles. The needles have thin precision sharp tips to minimize the penetration force and discomfort.

3. Diabetes management apps

Diabetes management apps can track food calorie quality, carb counts, weight, and so on. Some useful apps:

• Fooducate (available for Apple and Android) to count the carbohydrates and other nutrients in  food, or calculate overall calorie consumption. 
• CalorieKing is an app with an extensive collection of nutritional information, even for favorite take-out. 
• Medical ID offers medical information to deal with emergencies. Setting the patient’s profile helps the caregivers to store information such as allergies, medical contacts, available medicines, etc.

4. Instructional Videos

There are several popular YouTube channels with videos for older adults with diabetes and their caregiveres. A few to get you started:

• Managing medications
• Foot care
• Getting ready for your diabetes care visit

5. Healthy alternatives cookbooks

Whether your loved one has a taste for Mexican or soul food, you can find healthy alternatives to these meals in many cookbooks. If you’re just getting started and maybe not the best cook, various cookbooks cater to your needs, including:

• Soul Food Love
• The Mexican Keto Cookbook
• The Diabetic Cookbook for Beginners

6. Assistive and adaptive clothing devices

Adaptive and assistive clothing, footwear, and devices can use to make day-to-day care, including dressing, bathing, and eating, a bit easier. Adaptive clothing and footwear are particularly important for older adults with diabetic complications, like wounds or fluid retention. These complications can make regular clothing and footwear difficult and uncomfortable.

7. Online Resources and Support Groups

American Diabetes Association (ADA)

Support groups help to decrease isolation, giving people the sense that others are in the same boat. The American Diabetes Association (ADA) are also tapped into Aunt Bertha’s extensive repository of community resources that you can search through for just about anything, from help with transportation to accessing disability benefits and more.

The Association of Diabetes Care and Education Specialists (ADCES)

The Association of Diabetes Care and Education Specialists (ADCES) has a database that you can search to find a free diabetes education program near you. These classes typically run for about 6 weeks, meeting once a week for two hours and providing invaluable information for caring for a loved one with type 2 diabetes.

JDRF (Juvenile Diabetes Research Foundation)

Despite its name, JDRF’s TypeOneNation Community Forum attracts mostly adults who have aged into adulthood or old age with type 1 diabetes or their family members. There is a dedicated, knowledgeable moderator. I have found the advice on here to be unparalleled.

You can also submit a question to their volunteers who can provide one-on-one support, although medical or legal advice isn’t offered.

Type 1 Reddit

Here’s a place to share your successes, vent, get tips, or check in with others on just about anything related to type 1 diabetes care. I’ve gotten great tips from other users here, such as how to travel and get through TSA with a bag of diabetes supplies.

Excerpted with permission from the Kapok: Caring Across Cultures blog post How to Be a Caregiver for a Diabetic Patient.