Diabetes in the Elderly
As you begin your journey in becoming a Personal Care Service (PCS) caregiver for an elderly patient suffering from diabetes, you will most likely have a mountain of questions such as what the disease is, what kind of treatment is available, how it can be prevented, and what your role is in supporting a diabetic patient.
This guide is here to help answer these questions and help you navigate the caregiving process.
Diabetes is a very common and potentially life-threatening disease highly prevalent in the United States. In 2018, a reported 26.8% of adults 65 years and older in the United States had diabetes. This number continues to increase over the years, and as there is no cure yet developed for the disease, being informed on how to prevent diabetes and alleviate its consequences is the best way to fight it.
What is Diabetes?
Put simply, diabetes occurs when the body cannot properly process the glucose it receives from food. Although it may at first appear complex and incomprehensible, there are many resources available to help you better understand the disease. There are certain key concepts which are important to understand when learning about the disease:
● The difference between Type 1 and Type 2 diabetes
The best way to combat diabetes is to understand it. Knowing the definitions and having general knowledge about these concepts is an important part of a caregiver’s role to best support a diabetes patient. By learning these, you are undertaking one of the most important parts of being a caregiver: investing time into understanding what the patient is suffering from to best serve their needs.
Glucose is commonly referred to as blood sugar, and is the basic form of carbohydrates. It naturally occurs in many processed and unprocessed foods such as legumes, fruits, bread, and dairy. In moderation, glucose intake is a healthy part of any diet. In large amounts, however, glucose can cause serious health problems, such as diabetes.
When glucose is not properly processed by the body, the glucose levels rise, and excess sugar stays stored in the blood. As we will explain in the next portion, insulin from your body will naturally transform the glucose into energy. That said, if there is either a lack of insulin or the insulin in your body does not function properly, diseases such as diabetes can arise.
Understanding what insulin is, how it functions, and how it affects diabetes, is key to understanding the disease. Insulin is a hormone in the pancreas which helps process glucose intake. The cells which store the insulin, called beta cells, release insulin as you consume glucose. The insulin then helps convert the glucose in the blood into energy and into the cells.
In short, insulin regulates the sugar in your body. If there is a lack of insulin or if it is not properly released, an excess amount of glucose stays stored in the bloodstream, and diseases and health issues including diabetes can occur. This is why supplementary insulin is administered to diabetes patients to help promote blood sugar regulation.
The Difference Between Type 1 and Type 2 Diabetes
One of the first things you are likely to learn about your patient when beginning your PSC caregiving is the type of diabetes they are suffering from. In this section, we will outline the differences between the two, what treatments each one uses, and what their respective causes are.
Type 1 Diabetes
According to the Center of Disease Control (CDC) official website, Type 1 diabetes is the least common of the two types, making up only 5-10% of all people with diabetes. It is an autoimmune disease which makes your body attack itself by halting the production of insulin. The CDC asp reports that symptoms of Type 1 diabetes arise when a large amount of beta cells have been killed.
Type 1 is most often diagnosed when the patient is young due to symptoms arising or because of a Type 1 diabetes family history. What is characteristic of the Type 1 diagnosis is that unlike Type 2, it is not due to lifestyle choices, and exactly why there are people who are unable to produce enough insulin is still unknown.
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes, accounting for 90 - 95% of diabetes cases. It is caused when cells develop resistance to insulin. As explained before, if insulin is not properly released, or cannot produce enough to fight the resistance of the cells against the insulin, too much glucose remains stored in the bloodstream.
The cellular resistance found in Type 2 diabetes is often due to environmental conditions and unhealthy lifestyle choices. Due to the high cases of diabetes in the United States, it is especially important to be attentive to what makes someone more likely to succumb to the disease. Risks which can lead to the development of diabetes include:
● Lack of physical activity such as sports
● Certain racial demographics
● High cholesterol
There is no one way to know whether someone is sure to have diabetes without getting tested. Staying aware of the symptoms which may indicate diabetes or prediabetes is important for anyone, especially those who fall within one of the aforementioned categories of demographics more likely to have diabetes.
Understanding what prediabetes is and its relationship to Type 2 diabetes is also an important part to understanding the complexity of the disease. If someone is prediabetic, it means that they have a health condition where their blood sugar levels are too high, but not high enough to be considered diabetic. If action is not taken, it can be an early stage to diabetics.
Although there is no cure to diabetes, there exist ways to reverse prediabetes. The same kind of lifestyle changes expected of diabetic patients can be applied to prediabetic patients to help lower blood sugar levels. The CDC recommends that once diagnosed as prediabetic, a patient should aim to lose 5-7% of their weight if they are obese to prevent diabetes from developing.
Symptoms of Diabetes
It is important to know the symptoms of diabetes so that treatment for the disease may begin as quickly as possible in order to prevent life-threatening complications. Although they tend to be more apparent for Type 1 patients, symptoms can occur for both types. These include:
● Increased urination
● Extreme spikes of thirst or hunger
● Blurred Vision
● Increased stress levels
These symptoms are especially important to monitor and have checked if there is a history of Type 1 diabetes in the patient’s family medical history. In the next portions, we will discuss the ways to test for diabetes, what treatments are available for each type, and how to prevent diabetes in prediabetic patients.
Testing for Diabetes
Each type of diabetes has its own method of testing to check for the disease. It is a good idea to become familiar with the different tests in case the patient’s medical team uses any medical lingo about testing results. It is also important to better help remind the patient of their tests if they suffer from memory loss. The most common tests for diabetes include:
● A1C Test
● Fasting Plasma Glucose (FPG)
● Glucose Tolerance Test
No matter the type, all diabetes patients will have regular check ups and tests run regularly for the rest of their lives. As a caregiver, understanding the differences between these tests may help you better understand your patient’s medical trajectory and what to expect when they have their medical check ups.
This test is a common test to check for Type 2 diabetes, prediabetes, and to check the status of the patient’s diabetes if previously diagnosed. According to the CDC, the test checks sugar levels in the blood of the patient over the past 3 months by measuring the sugar coating the blood cells.
If the results fall higher than 6.5%, the patient will be diagnosed with diabetes. If they fall between 5.7% and 6.4%, the patient will be considered prediabetic. Anything below those numbers is considered normal and not a sign of diabetes. People already suffering from diabetes will have an A1C test administered twice a year to see if blood sugar levels are stable.
Fasting Plasma Glucose (FPG)
This test involves fasting, or abstaining from any food or liquid intake other than water for eight hours, before receiving the test. The test measures the patient’s blood sugar and, as with the A1C test, can diagnose diabetes or prediabetes. A diabetes diagnosis requires blood sugar levels at or above 126 mg/dl.
Glucose Tolerance Test
The Glucose Tolerance Test measures the glucose breakdown in a patient’s system by having them drink a liquid containing glucose, not eating for eight hours, and receiving a blood test. This test can also be used to determine whether a patient has diabetes.
Treatment for Diabetics
Unfortunately, there is no cure for diabetes. There are treatments available to prevent the development of the disease in prediabetics, to prevent life-threatening complications, and help manage living with diabetes. We will discuss treatments for each type of diabetes and how to maintain a healthy lifestyle for those living with diabetes.
Treatment for Type 1
Type 1 diabetes requires the patient to inject insulin manually everyday for their entire life. If not done regularly, the consequences can be fatal. There are different kinds of insulin intake options, including short-acting, rapid-acting, intermediate-acting, and long-acting insulin. The administration of the insulin is done by injection or through the use of a pump.
Some patients may receive a closed-loop insulin delivery device which acts as an artificial pancreas to distribute insulin into the body. The device includes a measurement tool used to check blood sugar levels regularly and release insulin accordingly.
Certain lifestyle choices are also recommended by doctors to Type 1 diabetes patients, which are similar to those for Type 2 patients. This includes counting carbohydrate, fat, and protein intake, eating fruits and vegetables, and regularly doing physical activities.
Treatment for Type 2
The most common treatment for Type 2 diabetes is lifestyle changes. There is no cure for diabetes, but diabetes patients who closely follow certain medical recommendations for their diet and day-to-day lifestyle choices can help reduce the effects and potential consequences of Type 2 diabetes. These changes include:
● Calorie counting to regulate glucose intake
● Opting for high-fiber instead of high-carb foods
● Very little sugar intake
● Working out 30 minutes a day
● Monitoring blood sugar regularly
Some patients may be prescribed medication to help maintain blood sugar levels. These three most common include Metformin to help lower glucose production, Sulfonylureas to help promote insulin secretion, and Glinides to promote insulin production in the body. These do not replace the recommended lifestyle changes, however.
Health Care Team Management Plan
The official Agency for Healthcare Research and Quality website defines a health care management plan as a “team based-patient centered approach” to implement a support system for patients suffering from disease. The plan encompasses risks, demographics, and conditions regarding the specific patient to best fit their needs.
Education about the patient’s illness is an important part of giving proper care. If you are a caregiver for an elderly diabetes patient, and are part of a health care management team, it is important to be informed of what effects the illness and its treatment have on the patient’s life.
Complications From Diabetes
The list of possible complications due to diabetes is extensive. The Mayo Clinic lists a variety of long-term complications which can occur in patients suffering from diabetes. These include cardiovascular disease, neuropathy, kidney damage, skin problems, and Alzheimer’s disease. Closely following their doctor’s recommendations for treatment of diabetes is the best way to prevent these life-threatening complications.
Diabetes in Seniors
Diabetes in seniors in the United States is very common, with a reported 25% of Americans aged 65 years and above suffering from the disease. This rate continues to increase, and understanding how to care for the elderly with diabetes is crucial to alleviating the suffering caused by it.
Age plays a role over time making insulin more difficult to be properly released. Older people who have been exposed to high glucose or sugar intake longer cause them to be at higher risk for Type 2 diabetes. Age also weakens the immune system, making it harder on the body to fight the disease.
Issues with mobility can make fighting diabetes difficult for seniors, as well as dietary restrictions they may have for other health problems. One way to support an elderly patient suffering from diabetes as a caregiver is finding easy ways to incorporate exercise into your patient’s daily routine, such as going on short walks two to three times a day.
Racial Demographics Regarding Diabetes
The distribution of patient’s suffering from diabetes disproportionately affects people of color or marginalized communities such as the African American, Native Americans, and Hispanic communities. Although it is not clear why this is the case, unequal access to medical resources, education, and healthy food are likely factors of these disparities.
According to the CDC 2020 National Diabetes Statistics Report, Black, non-Hispanic Americans made up the largest demographic of diagnosed and estimated undiagnosed diabetes patients from 2013 - 2016. Black, non-Hispanic Americans make up 16.4% of the United States diabetes population, while making up 13.4% of the nation’s general population.
Native Americans have the highest rate of prevalence in a ethnic demographic, with 14.9% of Native Americans diagnosed with diabetes. This was followed by prevalence rates of 12.% of the hispanic community and 11.4% of the African American community.
The same report also showed that socioeconomic status and education level were linked to probability of having the disease. The percentage of adults without a high school education were found to be twice as likely to have diagnosed diabetes than those with more than a high school education.
Staying Healthy With Diabetes
The best way to live with diabetes is to live the healthiest overall lifestyle possible. This becomes more difficult with age, as mobility limitations and other health issues arise. That said, there are some easy steps which can be taken to make a world of a difference.
Manage Blood Pressure
Managing blood pressure is an important part of any healthy lifestyle, especially if dealing with diabetes. Exercise and general physical activity is one way to keep blood pressure at a stable level. Losing weight if the patient is obese is another.
Cholesterol is found most in saturated and trans fats. Eliminating foods with a high content of these, such as red meats, is an easy way to alleviate cholesterol intake. Increasing the amount of fiber in a diet can also help keep cholesterol levels down.
If a patient is diagnosed with diabetes, they will likely be asked whether they smoke, and be told to quit smoking to prevent the evolution of diabetes-related cardiovascular complications. Smoking can also weaken the immune system and decrease the patient’s ability to perform physical activities.
Checking Feet for Red Patches
Red patches may form on the body, notably the feet, with diabetes. The most common diabetes-related skin problems are acanthosis nigricans, diabetic dermopathy, and necrobiosis lipodica diabeticorum. There are treatments available for these symptoms, and the patient should contact their doctor immediately if they notice red patches popping up.
Getting Flu and Pneumonia Vaccines
Diabetes, like any disease, weakens the immune system as the body tries to fight for itself. According to the CDC, there is a higher risk that people with diabetes die from pneumonia and influenza as they can raise blood sugar levels. Staying up to date with vaccinations is an easy way to prevent complications from these illnesses.
Yearly Eye Exams
It is recommended that people suffering from diabetes get eye exams by an eye-specialized doctor every one or two years. This is because diabetes can negatively affect someone’s eyes, such as with the development of diabetic eye disease. If left untreated, this disease can lead to blindness.
Regular Cancer Screenings
There is a reported link between higher probability rates of certain cancers developing in diabetes patients. Although the exact link is not yet determined, it is important for diabetes patients to receive regular cancer screenings for their age and sex group. The most common cancers which arise in diabetic patients are pancreatic and liver cancers.
Talking With the Medical Team
Understanding and navigating all of the information surrounding diabetes can be difficult for patients, especially because much more research still needs to be done on the disease. Maintaining open, honest, and regular communication between the patient and the medical team is a way to decrease the patient may feel due to their diagnosis.
Although it may be common among the United States population, there is still a lot of research to be done on the diabetes disease. If you are a caregiver for an elderly person suffering with diabetes, be sure to attentively read all of the information given by the patient’s medical team. That way, you will best be able to understand what the patient is living, and the impact it may have on their life.
The fact that there is no cure for diabetes can be a difficult thing to process for recently diagnosed patients. That said, it is important for them to know that they can take control of their lifestyle in order to make the process as smooth as possible. Helping them in making these changes is one of the best ways a caregiver can provide help to a diabetes patient.
As a caregiver, it is important that you spend time taking care of yourself, as the kind of work you are undertaking can be mentally draining. There are online groups and resources available for caregivers, such as The Caregiver Action Network and the Family Caregiver Alliance. Self-care is an essential part of caregiving, so do not hesitate to reach out for help if you find yourself struggling.
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