Diabetes After 60: A Home Care Guide

What diabetes is, in brief

Diabetes means the body cannot keep blood sugar (glucose) in a healthy range, either because it does not make enough insulin or does not use it well. Most older adults have type 2 diabetes, linked with age, weight, family history, inactivity and diet. Over years, high sugar damages small and large blood vessels and nerves, causing complications: eye disease (retinopathy), kidney disease, nerve damage (neuropathy) especially in the feet, heart attack and stroke, foot ulcers and infections. Good control reduces these risks. But in older, frail adults, over-tight control with medicines that can cause low sugar can be harmful. So targets are individual.

Individual targets

The doctor will set targets for blood sugar and for HbA1c (a three-month average) based on age, health, other illnesses, risk of low sugar, life expectancy and what matters to the person. A fit 65-year-old may have tighter targets than a frail 85-year-old with dementia. Ask: What are my parent's fasting and after-meal targets? What HbA1c are we aiming for? What readings are too low or too high? What do we do if outside the range? Write the answers. See fasting and post-meal sugar targets and normal ranges for older adults.

Checking sugar at home

Home monitoring helps if it changes decisions. Ask the doctor which tests, how often and when (fasting, before meals, two hours after meals, bedtime), since needs differ: people on insulin or some tablets need more checks; those on diet or certain tablets may need few.

• Choose an easy meter with a clear screen, big buttons and simple strips; check coding and expiry; see glucometer buying guide and glucose strips and lancets guide.
• Learn the technique: wash and dry hands, use the side of a fingertip, apply a drop to the strip, record the result; see how to test blood sugar at home.
• Keep a log of results, meals and symptoms; bring it to appointments.
• Check your meter against a laboratory test occasionally.
• Dispose of lancets safely.
• Continuous sensors may help some people; ask the doctor; see cgm sensors for older adults.
• Poor eyesight or tremor: talking meters or help from a carer; see monitoring with poor eyesight or tremor.
• Treat the person, not only the number: symptoms matter.

Food for Indian kitchens

There is no single "diabetic diet". The aim is regular meals, steady carbohydrate, good protein, fibre and enough calories, without unplanned weight loss in the frail. A dietician can tailor a plan; see nutrition for diabetes after 60.

• Do not skip meals, particularly on medicines that can lower sugar. Eat at regular times; add a small snack if advised.
• Choose complex carbohydrates: whole grain rotis, millets such as ragi and jowar, brown or parboiled rice in portions, oats, dalia, with vegetables and pulses.
• Control portions of rice, roti, potato and sweets, rather than banning them.
• Add protein to each meal: dal, pulses, curd, paneer, eggs, fish, chicken, soya; see how much protein do seniors need.
• Fill half the plate with vegetables, with salad and leafy greens.
• Limit sugar, jaggery, honey, sweets, sweetened drinks, fruit juices and refined flour products; fresh whole fruit in modest portions is fine for most.
• Reduce salt; see hypertension home care guide.
• Hydrate; see hydration for older adults.
• Beware of "diabetic" products and herbal remedies that promise to control sugar; some interact with medicines or cause low sugar; ask the doctor; see supplements and medicine interactions.
• Festivals, weddings and fasting: plan; talk to the doctor before fasting; see fasting, festivals and older adults.
• Poor appetite or weight loss in an older person with diabetes is a concern; do not restrict food further without advice; see malnutrition in older adults.

Activity

Regular, safe activity improves sugar, heart health, strength and mood. After a meal, a gentle 10 to 15 minute walk helps many people. Check with the doctor first, particularly with insulin or tablets that can lower sugar, heart problems, eye or foot complications. See exercise with diabetes, walking programme for older adults and chair exercises for seniors. Carry sugar when exercising on medicines that can cause lows.

Low blood sugar: the main danger

Low sugar (hypoglycaemia) is common in older adults on insulin or certain tablets, especially if they eat less, are ill, vomit, drink alcohol, exercise more or have kidney problems. It causes falls, confusion, seizures, heart rhythm problems and hospital admissions. Symptoms: sweating, shaking, hunger, fast heartbeat, headache, blurred vision, confusion, irritability, drowsiness, unusual behaviour, sometimes nothing at all ("hypoglycaemia unawareness"), particularly in the elderly or those on some heart medicines.

What the family should know - Know your parent's lower limit, from the doctor; commonly, treat below about 70 mg/dL, or as advised. - If awake and able to swallow: give fast-acting sugar as the doctor has taught, such as glucose tablets, a glass of fruit juice or sugar dissolved in water; wait 15 minutes, recheck, repeat if still low, and follow with a snack or meal. - If drowsy, confused, unable to swallow safely or unconscious: do not put food or drink in the mouth. Call 112 immediately, place the person on their side and stay with them. If an emergency injection kit has been prescribed and you have been trained, follow the instructions. - Tell the doctor about every low, even if it recovered, since medicines may need adjustment. - Never give extra insulin or tablets to "treat" a high reading without the doctor's plan.

Prevention: regular meals, medicines as prescribed, extra checks when ill or eating poorly, carry sugar, avoid alcohol on an empty stomach, know the signs. See diabetes and low-sugar emergencies and hypoglycaemia in older adults.

Very high sugar and illness

Sugar can also rise dangerously, with extreme thirst, frequent urination, weakness, drowsiness, vomiting, abdominal pain, fruity breath or breathlessness; call 112 or go to hospital for confusion, severe drowsiness, vomiting or rapid breathing. During illness (fever, infection, vomiting, diarrhoea), sugar can swing: check more often, keep drinking, eat small amounts, and call the doctor the same day for advice about medicines on sick days; do not stop or change medicines on your own. See monitoring during illness.

Feet

Daily foot checks are essential: look for cuts, blisters, redness, swelling, corns, cracks and nail problems; never walk barefoot; wear well-fitting shoes and seamless socks; keep feet clean and dry; avoid hot water bottles and cutting corns at home; see a podiatrist or doctor promptly for any sore. See diabetic foot care at home, diabetic foot ulcers: prevention and early warning signs and neuropathy foot care.

Eyes, kidneys, heart and nerves

• Eyes: a yearly dilated eye examination, even if vision seems fine; report sudden vision changes; see diabetic eye care.
• Kidneys: annual urine and blood tests; control blood pressure; avoid unnecessary painkillers; see chronic kidney disease home care.
• Heart and blood pressure: keep blood pressure and cholesterol in range; know heart attack and stroke signs; see after a heart attack: recovery at home and stroke warning signs and the first hour. Diabetes can cause "silent" heart attacks with unusual breathlessness, nausea or fatigue.
• Nerves: tingling, numbness and burning in feet and hands; protect feet and tell the doctor.
• Teeth and gums: regular dental care; see oral health and general health in seniors.
• Skin and infections: keep skin clean and dry; treat infections early.
• Vaccines: discuss with the doctor; see vaccines for older adults in India.

Medicines: safe habits

• Take medicines exactly as prescribed, at the right times in relation to meals.
• Use a pill organiser and alarms; see pill organiser guide and medicine reminders for forgetful parents.
• Insulin: store properly, rotate injection sites, check doses (with a magnifier or pen device if sight is poor), and ensure a carer knows the routine; see giving injections and insulin at home.
• Never stop, skip or change doses without the doctor, even if sugars are low; call for advice.
• Bring all medicines to visits; review the list regularly, since kidney function changes and doses may need adjusting; see polypharmacy and deprescribing.
• Beware new medicines from other doctors and over-the-counter products.
• Keep supplies of strips, lancets and medicines, including for travel and power cuts; insulin needs cool storage; see power cuts and older adults.

Memory, mood and independence

Diabetes care involves many daily tasks. If your parent has memory problems, simplify: fewer medicines, fixed routines, carer supervision and relaxed targets; see dementia and medicines at home. Low mood is common; see depression in older adults. Keep independence where safe.

Regular reviews

Ask the doctor for: HbA1c every three to six months; kidney tests, cholesterol and urine protein yearly; eye examination yearly; foot examination yearly or more; blood pressure at every visit; medicines review; vaccinations; weight and nutrition checks. See keeping a health record at home and preparing for a doctor's visit with a parent.

When to ask a professional

A doctor or diabetologist sets targets and treatment. A diabetes educator or nurse teaches monitoring and injections. A dietician adapts meals. A podiatrist and eye doctor check feet and eyes. A pharmacist can review medicines. For senior services, call Elderline 14567. For confusion, unconsciousness, seizures, severe vomiting or breathlessness, call 112.