Diabetes has become a common chronic condition in the aging population. It is often associated with obesity which is a growing concern in health care. 

Learning to manage diabetes will require some lifestyle changes as well as frequent blood glucose monitoring both by periodic scheduled fasting blood tests which are referred to as an A1C test or hbA1c and by a frequent self-testing routine.

Diabetes mellitus is a complex chronic condition that can have some very individualized results. 

Once your loved one receives the diagnosis of diabetes or has been noted to have prediabetes, it’s important to learn about the disease and to keep track of how your loved one’s body reacts to foods, exercise, diet, and medications prescribed.

One of the best ways to help with your loved one‘s diabetes care is to make sure to attend MD appointments with your loved one and ensure the doctor has all of the necessary paperwork from your loved one so that you can ask, and get answers to, questions. 

Make a list of questions for each doctor‘s visit to be sure you’re getting the information you need. Some possible questions you will need to discuss with the physician include:

 

1) What type of diabetes does my loved one have?

There are two major types of diabetes. One is Type 1 diabetes which used to be referred to as insulin-dependent diabetes. This type of diabetes used to be thought of as the type that mainly children and young people get diagnosed with. 

Through extensive research, it has been learned that in Type 1 diabetes, the beta cells in the pancreas no longer produce any insulin and the person with this type of diabetes must take insulin injections routinely. It can be diagnosed at any age.

The other is Type 2 diabetes in which the body continues to produce some, but not enough insulin, and may or may not have developed some resistance to the insulin the body produces. Over time, the beta cells diminish and the body produces less and less insulin. In this way, it is diagnosed most often in those over 30. Oral medications can be used to manage blood glucose levels, but in some cases, supplementary insulin may become necessary as well.

In both types of diabetes, it is essential for your loved one to make lifestyle changes pertaining to their diet, activity and exercise levels, glucose testing, and medication management.

2) How did your loved one get diabetes and is there a cure?

It is not known why some people get diabetes and others do not. There is a known link to a family history of diabetes or to having gestational diabetes during pregnancy. 

Persons who are obese and especially those who carry the majority of their weight in their abdomen are at a high risk of developing diabetes.

There has been a major focus of research by the American Diabetes Association (ADA) for many years. There have been several breakthroughs in diagnosing and diabetes management, but there is no cure. 

Very tight adherence to the prescribed diabetes management plan can result in some weight loss and reduced blood glucose levels which can lead to a lowered need for medication.

3) What is meant by blood sugar level?

Blood sugar, also known as blood glucose, is the main sugar found in your blood. This sugar comes from the food you eat, such as carbohydrates and sugars that provide your body's main source of energy. The blood in your body carries this glucose to all of your body's cells for them to use for energy. 

Insulin is released into the bloodstream to manage the sugar within an acceptable range. When the body doesn’t produce any insulin (Type 1 diabetes) or enough insulin or has insulin resistance (Type 2 diabetes), the blood sugar must be managed by medications, exercise, and a diet lower in carbohydrates and sugar.

4) What is high blood sugar vs. low blood sugar and what symptoms should we look for?

When the body ingests too much sugar and carbohydrates or doesn’t produce enough or any insulin, the blood sugar will rise. 

Symptoms of high blood sugar, also known as hyperglycemia, include increased thirst, frequent urination, blurred vision, headache, and fatigue. Your mom likely had some of these symptoms of diabetes prior to her diagnosis.

Low blood sugar, also known as hypoglycemia, produces symptoms such as feeling shaky, becoming anxious or nervous for no apparent reason, irritability, a fast heartbeat, hunger, and feeling lightheaded or dizzy.

Ask the doctor how to treat either of these groups of symptoms as they can become an emergency if left untreated.

5) What is diabetes management?

In order to best manage diabetes, your loved one is going to have to make some lifestyle changes that might include more regular exercise and eating three balanced meals each day with lower amounts of sugar and carbohydrates. 

Here are a few more tips for diabetes management:

• • Lean protein and fiber are important aspects of a diabetic diet. 

  • Medications may also be necessary to manage blood sugar levels.

  • Your loved one may also need to test their blood sugar before meals and at bedtime.

  • Keep in mind that keeping a  log of your loved one’s daily test results along with their routine fasting blood sugar testing and hemoglobin A1c will help the doctor adjust medications and prevent diabetic complications. 

  • The hemoglobin A1c is a 90-day average blood sugar test that provides a window into the effectiveness of the management plan and her compliance.
    
    

6) What kind of testing do they need to do and how often?

Blood glucose testing can be done at home, or anywhere, one to four times a day with a simple finger stick. 

A quick prick of the finger with a lancing device will produce a small droplet of blood that is applied to a testing strip inserted into a meter that reads the glucose level. Normal glucose levels fall between about 72 to 90 mg/dL (milligrams per deciliter) fasting and up to 140mg/dL after eating.

Diabetics will often run higher. Ask the doctor how often to test and what parameters are acceptable for your loved one.

Some diabetics use a continuous glucose monitoring system in which a small wire is inserted under the skin every 10 to 14 days and is attached to a meter that can be read with a receiver or smartphone app. These are expensive devices and reserved for those who take insulin frequently or need more close monitoring.

7) Will the blood testing tell me how high their blood sugar is?

Yes, routine blood glucose testing will tell you the number of milligrams/deciliter of sugar in your loved one's blood at the time of testing. Low numbers will alert to possible symptoms of hypoglycemia and high numbers will alert to hyperglycemia.

Her doctor should have given you instructions for treating the symptoms and when to seek medical care.

8) What kind of medication will they have to take? Will they need to take shots?

At first, the doctor may not prescribe any medication and prefer to increase your loved one’s level of exercise and restrict their diet to see how their body reacts. 

Glucose testing may or may not be indicated. If that alone doesn’t help manage diabetes, your loved one’s doctor may prescribe oral medications such as metformin. If necessary, insulin may be prescribed as well which you or your loved one will have to inject as prescribed.

9) Can they ever eat cake or ice cream again?

Yes, but small amounts infrequently. Your loved one will need to adjust their carbohydrate intake accordingly. Regularly testing blood sugar and taking medications as prescribed will help account for it.

10) How can we find more information about diabetes that is reliable?

The doctor’s office may have some reading materials available or they can refer your loved one to a diabetic nurse educator, dietitian, or to diabetic classes in your community or on the Internet. 

Your loved one’s doctor may also refer her to a diabetic specialist known as an Endocrinologist to manage her diabetes and prevent complications.

The American Diabetes Association, the Centers for Disease Control and Prevention (CDC), and the National Institute of Diabetes and Digestive and Kidney Diseases are all good sources of information and education on diabetes

Preventing complications from diabetes is of the utmost importance from the time of diagnosis. 

Good glucose control and maintaining wellness is the goal. Your loved one may be at a higher risk of developing conditions such as high blood pressure and heart disease, high cholesterol, and triglycerides, kidney disease, and retinopathy in their eyes due to general aging. If the loved one you're caring for is a woman, she may have had polycystic ovary syndrome or even gestational diabetes in her childbearing years which may have increased her risk for women’s health issues.

Additionally, having a family history of diabetes is a big risk factor. If your loved one has a family history of diabetes and you are related to the loved one you’re providing care for, you may also be at an increased risk of diabetes. This applies to cardiovascular disease as well.

However, diabetes prevention is possible. Type 2 diabetes can be prevented or delayed with good weight management, a routine physical activity plan, and incorporating a healthy balanced diet. An additional note to keep in mind is that African Americans have a higher risk of developing diabetes.

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