Challenge #1: Addressing obstacles specific to older adults with type 2 diabetes
There's no denying that people with type 2 diabetes face significant hurdles to keeping the disorder under control. These include:
- Increased insulin resistance. Insulin resistance, or the body's inability to respond to and use the insulin it produces, tends to be more of a problem as a person ages, even if he isn't particularly overweight or inactive.
- Recognizing symptoms. Older people with diabetes often don't recognize symptoms of the disease . For example, one sign of this disorder is increased thirst, but older people tend to lose their ability to recognize this sensation. Or they may just chalk up frequent urination, another warning sign, to advanced age.
- Contradictory symptoms. When a person does have signs of type 2 diabetes, they may be confusing . For instance, a patient may feel tired, hungry, and shaky, all typical red flags for hypoglycemia or low blood sugar, but a test of his blood glucose may reveal that he's actually experiencing hyperglycemia or high blood sugar.
- Complications. Older people with diabetes often aren't diagnosed with the disease until a complication linked to this condition, such as vision loss, nerve damage, kidney failure, or cardiovascular disease, emerges -- which suggests someone may have had the disorder for several years.
- Memory loss. Coping with diabetes requires a reasonably high level of cognitive or mental function, given the need to follow a treatment plan that includes diet, exercise, and medication components as well as blood sugar testing and other self-care measures. Those with diabetes have a higher incidence of both dementia and Alzheimer's disease , making it even harder for them to perform multiple, complex tasks. Even garden-variety memory loss associated with aging can impact how well a person deals with diabetes.
- Blood sugar monitoring. Encourage the person in your care to test regularly and often so he has a good sense of his blood sugar numbers, which takes the guesswork out of whether or not he's in his target range -- regardless of symptoms.
- Routine checkups. Make sure he has regular checkups and visits with specialists to address any diabetes-related complications he may have.
- Tracking sheets. Help him set up simple systems for monitoring his blood glucose control, such as a preformatted sheet or logbook for recording his test results, as well as a similar sheet for tracking medications. (The American Society of Consultant Pharmacists offers a downloadable medication record form . )
- Help from professionals. If you're unsure about his ability to practice self-care, discuss any mental impairment issues with his primary diabetes healthcare provider. It's helpful if you provide specific examples of the difficulties he faces in managing his disease.
Challenge #2: Juggling dual or multiple diagnoses with type 2 diabetes
Even if a diabetic is still as sharp as a tack, he may suffer from other aging-related ailments, such as poor vision, arthritis, or hearing impairment, that make managing this disease a greater challenge. A heart attack , stroke, or health complaints such as high blood pressure, high cholesterol, or obesity can further complicate his self-care regimen and speed up the progression of common diabetes complications. In turn, diabetes can exacerbate the symptoms of such coexisting conditions.
- Simplify pill taking. Help him deal with dual or multiple diagnoses by setting up a streamlined approach to pill taking. Also discuss any possible adverse drug interactions related to multiple diagnoses and medications with his diabetes doctor or pharmacist. For specific ideas, see our article on helping a patient follow medication recommendations .
- Seek professional help. Ask his diabetes educator or an exercise physiologist if mobility issues such as arthritis make activity difficult. These professionals can help figure out exercises he can do and will advise you if he has cardiovascular complications that may impact his ability to be active.
- Address the patient's specific needs. Supply a tape recorder if he has vision loss, so he can check medical information and keep records. Make sure a hearing-impaired patient receives a written record of any medication or treatment information.
Challenge #3: Making lifestyle changes with type 2 diabetes
In order to keep his diabetes under control, a patient needs to maintain a healthy weight, eat a variety of nutritious foods, get some exercise, and -- if he has a nicoti ne habit -- quit smoking. Of course, that's the same stock advice that a healthcare provider would offer any person, whether or not he has diabetes.
But unlike someone who's diabetes-free, the stakes are higher for a person with diabetes if he doesn't follow these recommendations. Excess weight, poor diet, a sedentary lifestyle, and a cigarette addiction can all wreak havoc on a person's blood glucose and, in turn, lead to long-term complications such as heart attack and stroke, as well as eye, kidney, nerve, and blood vessel damage.
Of course, unhealthy habits may be long engrained and thus hard to break. But the good news is there are many ways you can help him make the necessary adjustments to living with diabetes.
- Partner with the patient. Offer to accompany him to a diabetes education class, if you can, or on visits to see his primary diabetes doctor, diabetes educator, or dietitian, who are all trained to help him make transitions toward diabetes-friendly lifestyle changes. Partnering with him is essential in helping him make healthier choices. You may also benefit from educating yourself about the disease by attending a class or talking with his healthcare team.
- Exercise together . Take a walk or play golf with him to increase his activity level, and look for other ways to help a patient exercise .
- Cook healthier food. Prepare meals that are wholesome and include a balance of vitamins, minerals, proteins, fats, and carbohydrates, and search for additional ideas on helping him make dietary changes .
- Provide a prompt. Remind him when it's time for him to test his blood glucose or take his diabetes pills.
- Cheer him on. Provide encouragement for the good choices he makes and the results that follow. Perhaps he loses weight by carefully watching what he eats. Or maybe he needs less diabetes medication as a result of his increased activity level. Tell him how well he's doing -- he needs to know you're in his corner.
Challenge #4: Monitoring blood glucose with type 2 diabetes
The only way to know if a diabetic is meeting his blood glucose goals is if he routinely checks his blood sugar. How often he should test is a subject of discussion for him and his primary diabetes healthcare provider. But the truth is, the more frequently he does it, the more information he'll have to help him keep his diabetes under control.
Regular blood glucose testing gives him immediate insight into the way his body responds to food, activity, and medications. It also helps him uncover any patterns that may need addressing in his diabetes treatment plan.
That said, it's not uncommon for the newly diagnosed (or even those who've long had the disease) to find testing an inconvenient chore, or even painful. And some people with type 2 diabetes resist testing due to denial or anger about the disease.
- Hit the books. Help him see the value in regular testing by reviewing his testing logbook or journal with him, and point out patterns that may affect his treatment plan.
- Do it yourself. Offer to do the testing for him -- or find another caregiver who can -- if he has vision or dexterity issues that make testing a trial.
- Get the right gear. Talk with his doctor, diabetes educator, or pharmaci st about finding the right testing equipment for his particular needs. Consider more ideas for assisting a patient with blood sugar testing .
Challenge #5: Dealing with denial and depression with type 2 diabetes
A diabetic's attitude toward his diagnosis and how he handles managing this chronic condition can have a huge impact on whether he views the disorder as a challenging opportunity to care for his body or a major medical disaster that's best ignored. You'll want to strike a delicate balance between listening to a litany of complaints about coping with the disease and staying focused on finding the posit ives in a situation strewn with potential negatives.
- Denial and depression. Left unchecked or untreated, denial and depression can cause the kind of pessimism and despair that leads to failure on the eating, exercising, or medications front. This can result in a vicious cycle that makes a patient's diabetes worse.
Signs of depression include a loss of interest in activities that previously provided enjoyment, blood glucose levels that are suddenly and inexplicably worse, difficulty coping with self-care regimens, or acting more stressed than usual.
- Isolation. A common problem among older adults, isolation may exacerbate a patient's denial and depression. People with diabetes are about twice as likely to be depressed as people without this medical condition. But those who have a network of friends are less likely to suffer from depression than those without such a safety net.
- Accentuate the positive. Link medications to something the patient enjoys, rather than pointing out the dire pitfalls if he doesn't take his diabetes drugs as prescribed. If he's an avid walker, for example, remind him that taking his diabetes pills will allow him to continue taking long hikes for years to come.
- Find a support group. Talk with his diabetes educator about locating a support group of peers where the person you're caring for can blow off steam with companions who share similar concerns, or look for such a group online by searching under the key words diabetes online support group .
- Get a referral. Ask his doctor or another member of his healthcare team for a recommendation to a mental health expert, such as a social worker, therapist, or psychologist, if denial or depression is a significant problem for the patient.