The PA Support Service gets a number of enquiries from PAs wanting advice and information about diabetes. To answer this need, earlier in the year we ran two very successful PA courses on diabetes. We hope to run this again later in the year. In the meantime we thought we’d share our findings from that earlier course.
We’re going to look at some of the main issues which affect older people with diabetes. Most areas of care in diabetes are relevant to all age groups, but there are some specific changes due to growing older which might affect the diabetes of the person you care for.
Food choices
In some cases dietary advice for the older person with diabetes may differ from general recommendations. Older people are often more likely to be underweight than overweight, and there is a high rate of under-nutrition. It may not always be appropriate to reduce the fat, salt and sugar for every older person with diabetes. Poor or irregular eating can often be a cause of hypos.
Poor oral health, effects of some drugs on the digestive system, limited mobility, dexterity or vision can all cause discomfort associated with eating.
Fluid intake is often lower in older people which can cause dehydration, particularly during bouts of illness. People at risk should have a nutritional assessment and individual advice from a dietician to address areas of concern such as needing extra calories, meal supplements and replacements, weight reduction, low salt diet or manageable foods.
Personal food preferences are important in any diet plan and older people with diabetes should be able to continue to enjoy a wide variety of foods. There are lots of recipes for quick, balanced and nutritious meals on the diabetes UK website. Click here to view them.
Keeping active
Keeping active in later life helps to strengthen muscles, maintain mobility and balance and improves insulin sensitivity. It can help improve mental well-being and prevent falls. It’s important to help older people to keep as active as they are able.
A Physiotherapist can show you how to help with light resistance and balance training and exercises to build limb strength and flexibility.
Hypos
Hypoglycaemia or hypo occurs at blood glucose levels of less than 4mmols/l. Older people may have added risk factors which can lead to hypo:
- being prescribed five or more medication
- chronic kidney problems
- poor food intake
- having other illnesses or conditions such as colds or flu
Many older people find their hypo warning symptoms become less obvious, and some have no symptoms at all. This may mean that the first signs noticed by a PA/carer are:
- inability to concentrate
- personality change
- morning headaches
- raised temperature
- sleep disturbance
Hypos which go unnoticed can cause very unpleasant symptoms:
- confusion
- speech and self-care difficulties
- poor appetite
- aggressive behaviour
- unsteadiness and falls
- losing consciousness
- cognitive damage
- heart attack or stroke
Treatment
A hypo should be treated immediately in a conscious person with fast-acting glucose, such as a sugary (non-hot, non-milky) drink or some glucose tablets and followed up with something starchy like biscuits, a sandwich or the next meal. If someone is unconscious, call for medical help or an ambulance. Some older people may have a personal hypo box with hypo treatments and instructions for treatment.
Prevention
To prevent hypos, ensure the person you care for has regular mealtimes and snacks containing carbohydrate and to be aware of hypo symptoms and what to look out for. (Blood glucose monitoring can help to identify older people who may be at risk of hypos but must always be looked at together with longer term blood results like HbA1c to give a clear picture.)