Question:
My mom is 90 years old and has been living with type II diabetes since she was in her 50s. She has always managed her blood sugars via medication, adhering to a strict diet and routine visits to her endocrinologist. Mom’s doctor diagnosed her with dementia just a couple of years ago. Since mom has become more forgetful she has come to live with me. Her appetite has decreased and she does not eat the way she used to. Her clothing actually appears to be a bit loose now. When Mom does want to eat she frequently asks for foods that I know are not good for her diabetes. She requests cookies, cake, ice cream and other foods she always avoided in the past to keep her blood sugars under tight control. What should I do?
Answer:
Managing diabetes in a loved one can be overwhelming. Common advice for people with type II diabetes is to bring blood sugar levels down low in order to reduce the risks of long term complications such as heart disease and kidney disease. Managing diabetes in elderly people requires a different approach due to the unique challenges faced by this population. Examples of these challenges include Alzheimer’s disease, Parkinson’s disease, cancer and weight loss.
Liberal diet plans have actually been associated with improved food and beverage intake in the elderly population. The use of restrictive therapeutic diets should be limited in order to reduce the risk of unintentional weight loss and dehydration.
Thomas Yoshikawa, MD, deputy chief of staff for geriatrics and LTC at VA Greater Los Angeles Health Care System recommends the following:
Prevent hypoglycemia (low blood sugar) as a primary goal. People can suffer morbidity from hypoglycemia, but rarely pass away from hyperglycemia (high blood sugar).
Aim to keep HgbA1c (which reflects the average blood glucose level for 3 months) between 8 percent and 9 percent, fasting glucose between 100-180 mg/dL and bedtime glucose around 110-200 mg/dL.
Limit using insulin, since this poses a higher risk for hypoglycemia in people who may not recognize the symptoms of having a low blood sugar.
Food is a pleasure that becomes increasingly more important as we age. Liberalizing the diet can allow your loved one to enjoy this pleasure of eating for as long as possible. This does not necessarily mean that it is OK for all those with both diabetes and dementia to eat ice cream sundaes all day long. Each person’s situation must be measured individually. For instance, a sweet can be allowed once per day on a daily basis and medications can be adjusted. All foods can and should be enjoyed in moderation while keeping carbohydrate intake consistent throughout the day. Weight, appetite, age and cognitive status must all be considered when setting goals for your loved one.
Resources:
Munshi, M. N. (2016, February). Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Dietetic Association. Retrieved from http://care.diabetesjournals.org/content/39/2/308
Dada, J. H. (2016, June). Diabetes Management in LTC Patients. Today’s Dietitian, 12-14.
By Susan Dwork, The Jewish Home Family
Susan Dwork is a Registered Dietitian who has been with the Jewish Home Family at Jewish Home at Rockleigh since October 2011. Susan’s passion is to enrich the daily lives of her residents through food while at the same time helping them to meet their individual nutritional needs.
