Day-to-Day Care

As a person gets older, their diabetes-care program may need to change, even if their previous plan has worked for them for years. Why?

People tend to expend less energy during the day.

They may be unable to sense a blood-sugar low.

•  Older people often metabolize medications differently than younger ones, due to reduced gastric fluids and the number of medications they take every day.

•  It's harder to sense thirst, so dehydration is common.

•  The sense of taste is diminished, and may result in a lack of interest in food. Poor-fitting dentures or digestive problems can worsen the situation.

•  Arthritis may make it more difficult to perform day-to-day tasks.

•  Complications can make it harder to get the proper sleep and exercise necessary for blood sugar control.

As a result, it's important to work closely with the healthcare team to make sure that the diabetes regimen remains up-to-date. Here are some ways to help put that plan into action.

Tests and Treatments

Everyone's diabetes management program is different, so don't worry if your doctor makes a recommendation that doesn't precisely match what you've heard or read about. Instead, ask the doctor to explain a particular course of action in more detail. For example, the doctor may recommend a higher blood sugar target in order to avoid low blood sugar that could lead to a fall.

In addition:

•  Get to know all the daily, monthly, quarterly, and annual tests required to monitor the effects of diabetes.

•  Make sure to maintain regular appointments with the eye doctor, foot doctor, and any specialists.

•  Continue to see the dentist twice a year, even if the person you're caring for wears dentures. They're still at risk for gum disease and mouth infections - two common complications of diabetes.

•  At every doctor visit, share a list of all the medications and treatments the person you're caring for is currently using. Include prescription medications, vitamins, supplements, over-the-counter drugs, ointments, and anything else you think might be relevant

•  Use only one pharmacy, if possible. That way, the pharmacist can help watch for possible drug interactions.

Healthy Meals & Snacks

As we get older, our bodies absorb fewer nutrients and we have a harder time digesting fats. It's harder to smell and taste food. And a variety of factors - from trouble chewing to depression - can suppress a person's appetite. For all of these reasons, it's more important than ever to make sure the person you're caring for eats a healthy, balanced diet.

•  If the person you're caring for is living with you, try to eat together. Mealtime rituals are comforting and increase the feeling of normalcy in a person's life. And they can help decrease the social isolation many older people feel.

•  To aid digestion, increase high-fiber choices by substituting whole-grain products for refined breads, cereals, and rice.

•  For stronger bones, make sure calcium needs are being met - preferably with low-fat products.

•  Make sure they're drinking enough liquids. Many older people don't feel thirsty, even when they're dehydrated. Getting enough fluids will help their bodies use medications properly and keep them more regular. People experiencing incontinence will sometimes limit fluids in order to avoid embarrassment. Rather than cut back on fluids, talk to the doctor. They may recommend a regular bathroom schedule or another solution to the problem.

Ongoing Activity

Exercise is important at any age, but for older people it can help them maintain muscle tone and flexibility, stimulate circulation, improve regularity, stimulate the appetite, and help them sleep better at night. Even people with limited mobility, low vision, or other medical problems can benefit from increased activity every week.

•  Talk to the doctor for guidelines on how much exercise is appropriate, as well as suggestions for activities.

•  Use your imagination to come up with activities your parent or spouse will enjoy. Walking, gardening, swimming, dancing, and stretch classes at the local gym are all possibilities. Even if a person uses a wheelchair, lifting weights and performing arm stretches will help get their blood moving.

•  Older feet have less cushioning than younger ones do. Make sure that shoes fit well and have the appropriate padding for the activity at hand. Make sure to check shoes before putting them on - look for rough spots that can cause sores or pebbles that have managed to find their way inside.

•  Perform a daily foot exam. Due to nerve damage, many older people with diabetes have lost some of the sensitivity in their feet - they won't know there's an infection or injury without seeing it. If you find something wrong, don't wait for it to heal itself. Call the doctor.

•  Older muscles fatigue more easily and take longer to recover than they used to. Stretching before and after exercise becomes even more important as we age.

Monitoring and Medications

According to the Food and Drug Administration, older people take an average of more than four medications every day. This can lead to a complicated medication schedule and some unexpected side effects. Be sure your doctors and pharmacist are aware of everything the person you're caring for is taking - whether it's by prescription or over-the-counter.

•  Follow the blood sugar testing plan recommended by your doctor. Many people believe that they know what their blood sugar level is by the way they feel - but the tests prove otherwise. Plus, as people age, they become less and less able to sense high or low blood sugar. Testing is the only way to know for sure.

•  Create a printout of the names, dosages, and dosing times of all medications, and check off medications as they're taken. Include special instructions for drugs that should be taken with food, etc.

•  Make sure all medication is actually taken. According to researchers at Columbia University, more than half of all people over age 65 do not take medications as prescribed. This can lead to additional health problems.

•  Don't assume that poor balance, bladder trouble, hearing or memory loss, confusion, blurred vision, or other problems are just a part of aging. It may be a side effect of medication. Talk to your doctor immediately.

•  To help the person you're caring for retain as much independence as possible, try not to take over any more of the testing or medication responsibilities than necessary. For example, even a person with vision loss may be able to inject insulin if someone else fills the syringe.