Diabetes is getting harder for Dad to manage alone

What changes as diabetes and aging overlap?

Managing diabetes is a daily job: meals at regular times, medications on schedule, blood sugar checks, foot care, eye and doctor appointments. That job gets harder when vision fades, hands stiffen, memory slips or a spouse who used to cook is gone. Families often notice it through the kitchen first: meals replaced by snacks, or by nothing, and pill bottles that are too full or too empty.

Low blood sugar is the worry that keeps families up at night. The CDC lists common signs such as shakiness, sweating, nervousness, irritability or mental fogginess, lightheadedness and hunger, and notes that some people have no warning signs at all. Someone who lives alone may have no one there to notice.

What can a caregiver do, and what is outside their role?

Our caregivers support the plan; they do not run it.

• Meals on the plan. Shopping and cooking to the meal plan from his doctor, dietitian or diabetes educator, with meals and snacks at the times the plan sets. See Meal Preparation.
• Reminders. Reminding him to check his own blood sugar and to take his medications as prescribed, and helping with self-administration such as opening a pill organizer. See Medication Reminders.
• A daily log. What he ate, which reminders were given, and anything unusual, so the family and doctor can see patterns.
• Feet and skin. During bathing and dressing, clean dry socks and well-fitting shoes, and a word to the family about any blister, sore or redness. Toenail trimming for someone with diabetes is a job for a podiatrist.
• Getting moving. Company on the walks or activity his doctor encouraged.

Our caregivers do not administer medications. Checking blood sugar for someone, giving insulin or any injection, adjusting doses, and deciding what to do about a reading are outside non-medical home care. Those tasks belong to your father, a family member he trusts, or a licensed nurse through a home health agency. Our guide to home care versus home health care explains the difference.

How do we work with his diabetes care team?

His primary care doctor or endocrinologist sets the treatment plan. A diabetes care and education specialist (often called a diabetes educator) and a dietitian teach the daily routine, a podiatrist looks after his feet, and an eye doctor checks his vision. After a hospital stay, a home health nurse may visit if the doctor orders it.

Ask the doctor or diabetes educator for a written plan for low and high readings and keep it on the refrigerator. If your father shows signs of low blood sugar while he is awake and able to swallow, the caregiver follows the non-medical steps of that plan, such as reminding him to check his own meter and handing him the juice or snack the plan names, and calls the family. The American Diabetes Association says severe low blood sugar is an emergency and that if someone is unconscious, and glucagon is not available or no one knows how to use it, call 911 immediately. Our caregivers call 911 first, then you.

What does a typical starting plan look like?

• A morning visit of three to four hours: breakfast on schedule, reminders, a shower and foot check, lunch made and labeled for later.
• Or an evening visit: dinner on the plan, evening reminders, and a tidy kitchen.
• More hours if memory changes make the routine hard to keep. See dementia care at home.

Where this happens in our 16 counties

We support diabetes routines in Chambersburg, Waynesboro and Greencastle, where the Franklin County Area Agency on Aging at (717) 263-2153 can explain OPTIONS and home-delivered meals for residents 60 and older; in Reading, Shillington and Kutztown, where the Berks County Area Agency on Aging is at (610) 478-6500; and in Lebanon, Annville and Myerstown, where veterans may already receive care through the Lebanon VA Medical Center (see home care for veterans). Short daily visits can be hard to staff, especially in Fulton, Huntingdon and Juniata counties, so many families start with one longer visit that covers two meals. To set up a schedule around his meal plan, request a consultation.