My Story

My Story: What I Learned Caring for My Grandmother with Diabetes

By Vanessa

My grandmother is a tenacious and vibrant woman who was diagnosed with type 2 diabetes earlier this year. She had uncontrolled blood sugar levels along with other health issues and limited mobility. With no formal educational background, she doesn’t know much about diabetes or possible complications. Her low health literacy makes it difficult for her to utilize diabetes related health care resources.  “There are too many rules in my diet!” she would exclaim in Twi, her native dialect.  She also has low nutritional knowledge and at times would reduce her consumption of certain staple foods. She assumed that eating less of these foods would cure her body from the disease. Her daily diet in Ghana is mostly starchy and sugary foods with low nutritional benefits.  One staple meal that she eats quite often is called fufu:  a soft dough-like mix of cassava, plantain, and other flours served with different types of warm soups full of meat and/or fish.  Fufu is relatively high in carbohydrates and has a significant and rapid effect on my grandmother’s blood sugar levels.

As my grandmother’s caregiver, I provided diabetes care management and education.  My goal was to help her avoid blood sugar spikes keep her blood sugar in a healthy range before she went back to Ghana. Every day I checked her fasting blood sugar in the morning and again two hours after eating.  These results were reviewed by her PCP and nurse case manager.  I modified my grandmother’s meals and incorporated more green leafy vegetables, fiber-rich foods, whole-grain breads and old-fashioned oatmeal with almond milk and honey for added sweetness. I also introduced her to cooked quinoa and cauliflower rice as substitutes for fufu, white rice, and other fufu-like foods to give her meals a nutritional boost. After a meal, I would encourage her to take a walk to the local shopping plaza or to circle around the neighborhood for an hour.  Despite her stubbornness and fiery temper towards changes to her diet, we were able to improve her eating habits by stressing the importance of portion control.

My grandmother does not know how to pronounce diabetes or manage her care on her own, but making sure she understood that her medications, changes to her diet, and daily walks to her favorite consignment stores are effective tools for managing her blood sugar levels were key components to her care plan.  My experience as a caregiver was a wonderful opportunity to spend time with my grandmother, and it also highlighted the importance of diabetes education in following a care plan and reducing risk of complications.  I also learned how that approaching care in a culturally tailored manner that respects individual preferences, opinions and ideas is necessary for reaching optimal health.



Diabetes Care for Older People: Is It Different?

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

The Americans Diabetes Association has addressed the care of the older person living with diabetes  in their 2014 Clinical Practice Recommendations Standards of Medical Care. These recommendations do not define “older” by any specific numerical reference but instead are based on a person’s medical conditions. Quite honestly, this makes it easier for me to interpret these recommendations when I am caring for patients because I do not know what is considered “older” anymore. I think age is just a number that I personally hope keeps getting higher and higher, especially those decade celebrations because those silly cards are my all-time favorites.

The average lifespan of Americans is approximately 76 years for men and 81 years for women. This expectation has been slightly increasing over the years and everyone has an opinion as to why this is. I believe people are living longer due to a combination of better medical care, use of technology, and (quite frankly) attitude. I have been practicing for 30 years and I see people both living longer and living younger. I’d like to discuss this recommendation and offer some suggestions to help you and your family better understand and manage diabetes across your lifespan. I also want to remind you that these practice recommendations are just that: recommendations. Each person’s care should be individualized with their health care provider.

The Standards of Medical Care from the American Diabetes Association was developed because older adults with diabetes have a greater chance of premature death, cognitive impairment, and coexisting illness such as hypertension and heart disease. However, there are not many long-term studies available about the benefits of intensive control of blood sugar and blood pressure in the older population. The ADA has determined that people with few coexisting illnesses and intact cognitive and functional abilities should have similar goals for treatment as the general population. Those with multiple coexisting illnesses and some impairment (cognitively and /or functionally), end stage chronic illnesses, and/or severe cognitive impairment should have less stringent goals for treatment per the same recommendations. Health care providers need to consider that the goals for blood sugar management need to be directed to be sure that the acute complications of hyperglycemia, such as poor wound healing, dehydration, and coma, are avoided. It’s also important for health care providers to remember to screen for complications across the lifespan and individualize this screening to be most aware of complications such as visual and lower extremity injury that can develop quickly and seriously impact functional status.

Now, how can we break this down so people living with diabetes can use this information to stay well? As we age, we may be faced with challenges such as multiple medical conditions, decreased memory ability, decreased agility and mobility, and financial challenges. People with many medical conditions have to manage multiple medications and medical appointments. It’s helpful to bring a friend or family member to appointments to be sure all important information is provided to the health care provider, and make sure that the provider’s suggestions are understood. A visiting nurse home evaluation may be in order to help with medication safety.

People who are struggling with memory issues may forget when their appointments are. They may also forget if they took their medications which could have life threatening implications, including hypo or hyper –glycemia. Family members may be able to set up simple reminders like Post- it® notes on the bathroom mirror or the kitchen counter. A simple large calendar may help with the appointment reminders.

People with mobility issues may not be able to exercise as they once did, so glucose control may be hindered. They may also be at greater risk of injury from falling. A safety assessment of the living space may be needed to avoid falls. Osteoarthritis can make checking blood sugars, administering insulin, and food preparation difficult or even unsafe. They may actually not be able to do frequent glucometer checks, meaning medication dose(s) may need to be adjusted to ensure safety.

Financial needs are very important to identify and address as costs of medications, testing supplies, and food can definitely impede people’s health. Health care providers need to inquire about these issues as people may be too embarrassed to bring it up themselves. Referral to social services for assistance is an important piece to try to work on a solution to this problem.

These are complicating factors on their own, but people with diabetes may also have severe visual impairment as the chance of developing retinopathy increases across the life span. This factor alone can be a huge negative impact on a person’s health status. Diabetes is difficult to manage at times. It takes time and dedication for the person living with diabetes, their family, and their providers. Aging is another unavoidable bump in the road of management. Adjustments in your diabetes care plan are sometimes needed because of this unavoidable fact, but the goal of these changes is to continue your good health. I think that the best approach is not to get caught up in the A1C values, but rather continuing to do all you can to stay healthy and keep collecting those silly birthday cards!

Fitness, Guest Post

Changing Seasons, Changing Habits

By Monica

Changing the way we do things, especially if it’s something we’ve done for a long time, is the hardest task anyone can ask.  We create a comfort zone of tranquility, serenity and calmness that our mind comes to prefer.  But it is not always the best.

As we get older, our appetite changes.  Our metabolism is different too, and we burn fewer calories.  We need to change the way we eat and learn to substitute in healthier foods.  And in order to continue to maintain a good healthy lifestyle, our daily routine needs to shift in a more active and productive way.  It’s not always easy, but it can be done with support from friends and family.

Regular activity is not just for little kids or young people – we all need to be active, and it’s never too late to start.  We had such a long winter; now that spring is finally here we have a chance to go outside and enjoy the warmer weather.  It’s also a perfect opportunity to change some of your habits.  Rather than just sitting in the sun, go for a little walk.  If you can, bring along a friend or co-worker.  You’ll be doing something good for yourself and getting a chance to be social at the same time.

Is there an activity you’ve always wanted to try?  Go for it!  Just about everyone has something they’ve said they’d like to try “someday.”  Well, why not now?  If you go to a gym, ask if they will let you try out a class to see if you like it.  There are also some programs in Boston that plan community fitness events or offer free classes like yoga and Zumba in spring and summer.  The Boston Natural Areas Network is another great group that organizes community activities like bike rides, canoeing and gardening – great opportunities for families to do something healthy and active together.

Let the change in seasons inspire you to get out there and get moving.

Guest Post, My Story

Mother’s Day: Diabetes from a Daughter’s Perspective

 By Marilyn

Branch of bleeding heart blossoms

We have a tradition in my family:  I take my mother out for Mother’s Day dinner.  Every year she asks me where I want to go and I have to tell her “no, this is your day; where do you want to go?”  Whatever restaurant we decide on, there’s bound to be a Mother’s Day special including a soup, a salad, an entrée . . . and dessert. 

My mom eats everything—including things she’s not “supposed” to since being diagnosed with Diabetes.  At Thanksgiving last year, we had a lot of food.  She ate everything there.  My family will say “oh but it’s only one day, what’s the harm?”  Meanwhile, I try to stay on her and remind her to eat healthy. 

So I guess you could say I’m the “food police,” always watching what my mother eats.  She has a weakness for Turkey Hill ice cream and eats a lot more of it than I think she should.  My family calls me “the mean one” because I’m always on her about things like that, but I have good reasons.  I want her to be able to stay off pills and not have to take shots.  More than that, my uncle lost his leg because of Diabetes and I don’t want my mother to go through what he went through.  Still, she is a grown woman, and I can’t make her do anything she doesn’t want to. 

On the whole, though, she’s pretty good with managing her Diabetes (she’s a former nurse so she knows).  She takes good care of her feet and sees her foot doctor regularly.  Every week she takes a bus to Stop and Shop to buy produce and other fresh food.  For exercise she goes out and walks around the senior housing facility she lives in, though it sometimes gets a bit difficult in the winter with all the snow (I called her the other day but she didn’t answer, so I hope that means she was out walking). 

It’s been about 20 years since her diagnosis, and she has plenty of people looking out for her.  My sister and brother help out, and every week my sister-in-law visits and brings prepared meals (home made soups and other things) for Mom to keep in the freezer and heat up later.  I also bring over a lot of prepared food once a month for her.  And, of course, there’s me, the “food police.”  I’m tough on her at times but that’s only because she’s my mom and I want to make sure she’s okay.