Caring For Your Parent

Your Role

Listening is an important part of caring. If your parent no longer visits friends and family like in the past, you may be one of the few people who take the time to listen to what's on his or her mind. All it takes is a shared laugh to build closeness.

Individuals with type 1 diabetes usually take their condition seriously. People with type 2 diabetes often downplay its significance. Contrary to what your parent may be telling you, there's no such thing as "borderline diabetes" or "a touch of sugar." If your parent has type 2 diabetes he or she has a very serious disease. People with type 2 diabetes can suffer devastating complications including heart disease, kidney disease and blindness.

Tight Control

In 1999, the United Kingdom Prospective Diabetes Study showed that tight control of blood glucose levels in people with type 2 diabetes can prevent and slow the progression of these complications. But tight management involves a significant amount of work. Your parent may need help with monitoring blood glucose levels, checking his or her feet for sores, going to and from doctor appointments, and adhering to meal plans determined by the doctor.

Helping Your Parent Maintain Tight Control

Some older people don't eat well because other conditions - such as arthritis, poor balance or diminished eyesight - make it difficult to shop for and prepare meals. Your dad or mom may only need the occasional drive to the grocery store to enable him or her to keep to a diabetes meal plan. Your parent could just be too shy to ask for your help.

In people with diabetes, not eating well can lead to more than malnutrition. If your parent has type 1 or type 2 diabetes and is taking diabetes pills, he or she could experience low blood glucose levels. If levels drop too low, your parent may experience dizziness, trembling, headaches, confusion and/or double vision. Your parent needs to anticipate a potential drop in blood glucose levels and keep juice boxes and glucose tablets in the glove compartment of his or her car to raise blood glucose levels when needed. And your parent needs another means of transportation for the days his or her diabetes isn't under optimal management. If your parent is on any medication that can potentially affect his or her ability to drive a motor vehicle, your parent must notify the provincial motor vehicle department.

If you find that your mother or father isn't their usual cheerful self, it's important to know that people with diabetes are particularly prone to depression. As a family member, you can accurately spot signs of emotional, mental or behavioural change that point to depression. Your parent may try to convince you that his or her mood change is just old age. But old age isn't typically associated with sadness. Accompany your parent to the doctor. Depression can be successfully treated.

Diabetes Emergencies

If a parent has diabetes, everyone in the family must learn how to recognize and respond to a diabetes emergency. A quick response could save your parent's life.
Blood glucose levels that rise too high or drop too low can result in a medical emergency. If you're not sure whether your parent's glucose levels are too high or too low, give him/ her something sweet and get immediate medical attention. The sugar may help; if it doesn't, it won't make your parent any worse.
There are two types of diabetes' emergencies.

1. Hypoglycemia

Hypoglycemia results from very low blood glucose levels (usually less than 4 mmol/L). If your parent has type 1 diabetes, he or she may have missed a meal or snack, or exercised more than usual without adequately increasing food intake. Hypoglycemia can also result from vomiting, administering too much insulin or drinking alcohol. Hypoglycemia is much less common with type 2 diabetes but can occur if your parent is taking diabetes pills.
Hypoglycemia can develop in minutes. Early warning signs include shaky hands and sweaty palms. But if your parent has had diabetes for 15 or more years, hypoglycemia may occur without warning.
The signs of hypoglycemia include:

• cold, clammy or sweaty skin
• pallor
• hunger
• trembling, feeling nervous
• lack of coordination
• irritability, impatience, confusion
• fatigue
• headache
• blurred vision and dizziness
• abdominal pain or nausea
• eventually fainting and unconsciousness

If your parent is conscious, give him or her a readily absorbable form of sugar such as three glucose tablets, six LifeSavers™, ½ cup of juice or regular pop (not diet), or three teaspoons or three packets of sugar. If your parent has type 1 diabetes and a doctor has shown you how, inject glucagon, a hormone that causes the liver to release glucose.
If you are not totally confident about the state of your parent's health, don't hesitate to get medical help.

2. Hyperglycemia

Hyperglycemia occurs when blood glucose levels are too high. It develops over hours or even days. It can result from too much food, less than the usual amount of activity, not enough insulin or an illness.
The signs of hyperglycemia include:

• increased thirst
• increased urination
• fatigue
• agitation or confusion
• a sweet smell to the breath
• If your parent has type 1 diabetes, ask him or her to test for ketones in the urine. Seek medical advice if ketones are present.
• If your parent has type 2 diabetes and you think his or her blood glucose is high, call or visit their doctor.
• weight loss

Encouraging Positive Change

If your parent has type 2 diabetes, losing as little as five to 10 pounds can make a big difference in how effectively his or her body uses the insulin it produces. You may think your parent can easily lose 10 pounds, but your parent's opinion about this goal may be slightly different.
First off, acknowledge that making any change is difficult and that making a change that affects everyday life is particularly hard. The Canadian Mental Health Association suggests that advice from adult sons and daughters is a tricky proposition and is best avoided - unless it has been asked for. Let an outside person be the advisor. Your job is to encourage your parent.

Dr. J. Prochaska and colleagues at the University of Rhode Island discovered that people pass through five stages before they successfully change their behaviour. Recognizing what stage of change your parent is in will help you to offer the appropriate encouragement and support. Here are the five stages of change.

1. Precontemplation. Your parent is not only not thinking about making a change, he or she doesn't want to make a change and doesn't realize there's a need for change. If you're trying to encourage daily walks, your parent can list several reasons why taking a daily walk is not possible, but no reasons why he or she should. Gently try to increase your parent's awareness of how walking can help lower weight and benefit blood glucose levels.
2. Contemplation. Your parent is starting to see the benefits of walking but still has reasons not to walk. Send the message, "You can do it."
3. Preparation. Your parent has decided to take daily walks and is considering buying walking shoes. Show your support by offering to walk with your parent or suggesting a mall-walking program.
4. Action. Your parent has started walking and is bursting with pride and confidence. However, relapse is to be expected. Ignore your parent's failures and praise his or her efforts and accomplishments.
5. Maintenance. Once your parent has been taking daily walks for more than six months, he or she has maintained the change. To keep it up, your parent still needs your support.

Caring for Yourself

Think you can do it all? That's not only wrong, it's dangerous. Placing that kind of responsibility on yourself can lead to stress and burnout. Of course you want to give your mom or dad the world! But if you're already at your wit's end looking after your own family, carefully consider how much time and effort you have for your parent.

If adding significant caregiving duties to your schedule will stress you to the max, recognize that your parent will likely become stressed, too. Stress is contagious. For example, a study of cancer patients receiving chemotherapy found that their level of depression was directly related to the degree of their caregiver's depression. Talk to your parent honestly about your needs, feelings and time constraints.
If you can ease the strain of caregiving, you can improve the health and quality of life for both you and your parent. Here's how.

Be on the lookout for burnout. Symptoms of stress and burnout as depression, constant fatigue, poor concentration, hostility, low self-esteem and/or physical illness.

Learn to say no. Be realistic about what you can - and cannot - be responsible for.

Tackle only one problem at a time. If you have an overwhelming number of things that need your attention, pick one task and finish it. After finishing that task, only then move onto the next task.

Take time for yourself. It's common for caregivers to provide Cadillac care to their loved one, but neglect their own needs. Take a break from caregiving and go see a movie, get a new hairstyle or visit a friend. Do whatever it takes to rekindle your joy and your love of life.

Spend time with the rest of your family. Try not to let the demands of caring for your parent keep you from spending sufficient time with your spouse and children.

Share your feelings. A close friend, clergy or counselor can offer a sympathetic ear.

Give yourself credit. Your role is vital!

Building a Support System

The recognition that you need more help with caregiving usually comes after a significant change. Maybe your parent's diabetes has worsened, or maybe he or she has developed a new illness. Perhaps you've developed headaches and your doctor suggests that they're from exhaustion.
Doing it all yourself is usually the least effective way to provide care. Although people in your circle of family and friends may want to help, don't expect that help will come knocking on your door. You need to reach out for support and make a conscious effort to put a network of support in place.
Are there others in your family who can share the load? First, identify all the tasks that have to be performed. Then call a meeting and discuss what each family member can take responsibility for. Don't forget to include the younger members of the family. Kids can visit and read to your parent, run errands, and even clean his or her apartment.

For the tasks your family can't pick up, look beyond your immediate family. Involve your parent every step of the way. Remember, your mom or dad is not a child and deserves to participate in the planning for his or her care. Let your parent know what community services are available so he or she can make informed choices.
Most communities have well-developed services for older adults. Let your parent's family doctor guide your way. You may also want to consult government ministries, community information centres and seniors' centres. Here's a sampling of what may be available in your community.

Respite care. Temporarily, you may not be able to provide care because you're ill or you simply need a break. Home healthcare agencies, caregiver groups and hospice programs offer caregiving for a few days, weeks or months.

Day programs. Some hospitals, seniors' centres and nursing homes offer day treatment and adult daycare programs that provide social contact, activities and care throughout the day.

Visiting. Volunteer groups often provide services like "friendly visiting," transportation and shopping for the elderly.

Dining programs. Eating is a social activity. If your parent suffers from appetite loss, increased social opportunities during mealtimes may help him or her to eat more. Local parishes and community groups organise lunch programs for seniors.