Managing diabetes at home as you age

Diabetes in later life is managed differently from diabetes at fifty, and the change surprises people. The instinct is that control should get tighter with age. For a good many older people the safer approach is the opposite.

This is general information, not advice. Diabetes management is individual and belongs with a GP, an endocrinologist or a credentialled diabetes educator. Never change a medication or a dose on the basis of anything you read here.

What changes with age

The balance of risk shifts. Tight blood glucose control is aimed at preventing complications over decades. For someone who is frail, has several conditions, or is older, the near-term harm from a low episode can outweigh that long-term benefit. So targets are often relaxed rather than tightened, deliberately and on clinical advice.

Hypoglycaemia becomes the main danger. A low is not just unpleasant at eighty. It causes falls, confusion and hospital admissions, and the early warning signs people relied on for years can become blunted or unreliable.

Kidney function declines, which changes how some medications behave and sometimes means a dose needs reducing.

The regime often needs simplifying. Four injections and six tablets a day is a lot to manage with arthritic hands, poor vision or a failing memory, and a simpler plan that gets followed beats an ideal one that does not.

The questions worth asking at the next appointment

Take these to the GP. They are the ones that change how a household manages day to day.

1. What is my target range, and has it changed as I have got older
2. Which of my medications can cause a low, and what should I do if one happens
3. How often should I be testing, and does that need to change
4. Should this regime be simplified, given how I am managing it
5. How often should my feet, eyes and kidneys be checked
6. What should I do about food and medication on a day when I am unwell

Question six matters more than it looks. Illness, vomiting or not eating properly can throw diabetes management badly off, and having a plan written down in advance is far better than working it out while unwell.

The complications worth staying ahead of

Feet. The highest-value routine appointment in this whole condition. Reduced sensation means an injury may not be felt, and reduced circulation means it heals slowly, so small problems become serious ones. Regular podiatry and a regular look at the feet is not optional here, and our guide to foot care and podiatry at home covers what to watch for. Anything involving broken skin on the foot of a person with diabetes should be seen promptly rather than watched.

Eyes. Diabetic eye disease is treatable when caught, and it is found by looking rather than by symptoms, so the scheduled check matters.

Kidneys, monitored by blood and urine tests on a schedule the GP will set.

Skin and wounds generally, which heal more slowly and are worth taking seriously earlier than you would otherwise.

Eating, without the lecture

The generic diabetes diet advice aimed at middle-aged people can be actively wrong for a frail older person, and this is where families most often do harm with good intentions.

If someone is losing weight, restricting their food is the wrong direction. Weight loss and reduced muscle in an older person with diabetes is a serious problem in its own right, and it needs a dietitian rather than a stricter diet. Our guide to seeing a dietitian about eating at home applies here.

What is generally safe and useful: regular meals rather than long gaps, particularly for anyone on medication that can cause a low; something to treat a low kept where it can be reached quickly; and normal fluids, because dehydration makes everything worse.

A credentialled diabetes educator is the professional to ask for if the day-to-day management is the problem rather than the medication, and a GP can refer.

Where support work fits

A support worker does not manage diabetes. What they do is make a plan liveable and notice when it stops working.

They can shop and cook to a dietitian’s plan, keep regular mealtimes, prompt medications at the right hour, help wash and dry feet properly and look at them, get someone to podiatry and to the GP, and report anything that looks different. They can also make sure something to treat a low is stocked and reachable.

They do not adjust insulin or medication doses, do not give clinical advice, and do not cut nails or dress wounds. Those are clinical tasks and the boundary is set out in home nursing and support work.

The part that matters most is continuity. Somebody who has helped with those socks thirty times is the person who notices the red mark in the week it appears, and in diabetes that week is the difference between a dressing and a hospital admission. It is one of the clearest arguments for the same small Care Circle rather than a rotating roster.

For current information start at myagedcare.gov.au, and the Department of Health and Aged Care publishes program detail. If you want the podiatry, the dietitian or a diabetes educator arranged and the plan then followed between appointments, that is part of what we coordinate. Ring us and a person will answer.