Diabetes is a condition that calls for more than a one-size-fits-all treatment approach. To further complicate matters, many older people with diabetes develop unique barriers to managing their disease as they age.
Listed below are six tools to overcome poor diabetes control:
1. A better blood glucose meter
Poor vision and weak or shaky hands can impede the ability to measure blood glucose and properly administer insulin and other injectable antidiabetic medications.
Tool: Use a blood glucose meter with an easy-to-read display.
Stick with a simple meter without a lot of controls and displays that you don’t need. Having your syringes preloaded can eliminate the potential for under- or over-measuring insulin.
Additionally, many insulins and other injectable antidiabetic medications come in loaded disposable or reusable pens. Try to pick a pen on which the dose to be given is easy to read.
Alternatively, some insulin pens produce an audible “click” for each unit that is intended to be given as the dose is set manually. This audible cue allows you to know how many units to administer even if your eyesight is poor.
2. Simplified medication regimen
Diabetes and high blood pressure can gradually affect the health of blood vessels within the brain. Chronic vascular damage, particularly in the area of the brain that helps you problem-solve and perform complicated tasks, can limit your effectiveness in executing critical tasks, such as adjusting insulin levels, monitoring glucose, and scheduling meals.
Tool: Ask your doctor to modify your treatment regimen; for example, if appropriate, he or she could reduce the number of insulin injections you need each day or prescribe a single fixed-dose combination tablet instead of multiple tablets. You can ask a caregiver or pharmacist to preload a week’s worth of insulin syringes, which you can refrigerate.
Pillboxes are a good tool for keeping track of the medicines you take. And consider setting an alarm to remind you to eat and take your insulin or other diabetes medications. Also, ask your provider to review your blood glucose monitoring technique to ensure that you’re performing the task correctly.
3. Depression treatment
Common in older people, depression has been linked to diabetes. Being depressed can make it difficult to be motivated to follow your treatment plan, which can lead to poor glycemic control and a faster progression of heart disease. Also, diabetes-related distress, which is a function of the many issues that must be constantly addressed to effectively manage diabetes, can lead to depressive symptoms that can greatly reduce quality of life for older people.
Tool: Talk with your doctor if you have persistent feelings of sadness or have lost interest in people or activities you once enjoyed.
Other potential signs of depression include changes in sleep pattern, appetite changes that result in unplanned weight loss or weight gain, trouble concentrating, lack of energy, feeling nervous or anxious, or having suicidal thoughts. If you have three or more of these signs or have one or two for more than two weeks, talk to your doctor. He or she may refer you to a mental health specialist for counseling or prescribe an antidepressant.
Antidepressants are not habit-forming and can have a tremendous impact on quality of life.
4. Drug and supplement checkup
If you’re taking multiple prescription medications, a practice called polypharmacy, your risk for drug interactions and dosing errors increases. Complementary or alternative drugs, too, can trigger interactions and hypoglycemia.
Tool: Never presume that your doctor knows which drugs you’re taking, particularly if you see more than one health-care provider. At each visit, bring all of your medicines, supplements, and diabetes equipment for review. Your health-care provider or pharmacist can also check for side effects and potential interactions.
5. Fall avoidance
A number of conditions associated with diabetes—hypoglycemia, hyperglycemia, hypotension from high blood pressure drugs, peripheral neuropathy, poor vision and polypharmacy—make you susceptible to falling.
Tool: Don’t be afraid to tell your provider about falls you’ve had for fear of losing your independence. On the contrary, he or she can determine the reason for your falls and decrease the risk of falling by adjusting your hemoglobin A1c (HbA1c) target, for example. Physical therapy or a regular exercise program that incorporates gait and balance training can also help you regain your balance—and independence. A cane or a walker can help, too.
6. Urinary incontinence treatment
Urinary incontinence is common in older women with diabetes. What’s more, hyperglycemia can increase urine production.
Tool: Don’t be embarrassed to tell your doctor that you’re experiencing incontinence. He or she can prescribe treatment to improve your symptoms.
Diabetes self-management education (DSME) and diabetes self-management support (DSMS) are part of a structured approach that is recognized to provide patients with knowledge, strategies, practical tools and the confidence to improve their diabetes self-care. DSME and DSMS programs are covered by Medicare and have been shown to help people improve their glucose control.
If you’re newly diagnosed, DSME and DSMS programs can provide you with practical information such as tips for eating healthy, advice on managing stress, and education to help you learn the skills you need to effectively monitor your glucose and respond accordingly.
Even if you’ve had diabetes for years and have consulted with a diabetes educator before, ask your doctor about DSME and DSMS opportunities and follow up annually so you’re up-to-date on the latest in diabetes management strategies. What you learned years ago may no longer be recommended.
And even though you may have heard the information before, it’s not a bad idea to hear it again for additional reinforcement. You may be eligible for up to two hours of DSME/DSMS follow-up training each year through Medicare.
Another benefit: Talking to an educator has been shown to help diabetes-related stress levels in older patients who are concerned about their diabetes.