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Elders' with diabetes: their needs may be different

by Isabel Fawcett

Though a cure for diabetes has yet to be identified, diabetes research remains on the cutting edge of medicine. Now, there is even more promising news on the diabetes research horizon, specifically looking at the needs of elders with diabetes. For one passionate caregiver, the latest diabetes care news is like light at the end of a long tunnel.

Not only do I provide full-time assistive care to my soon-to-be 85-year old mother who has diabetes, I'm descended from a line of diabetic elders. A physician told me long-ago that my diabetes family history is sometimes known as a "double whammy." (I hope it skips a generation?) Therefore, I have a vested interest and long-standing passion for medical research and advances in diabetes care.

Diabetes Forecast 2010

In the March 2010 issue of Diabetes Forecast, a magazine published by the American Diabetes Association, there is an article called "Tailoring Treatments, Developing a High-Tech Tool to Customize Diabetes Care," (p. 68.) In part, the article speaks to the issue of whether or not "tight blood glucose control" is the best choice for diabetic elders.

Dr. Elbert Huang, Assistant Professor of Medicine, University of Chicago, is quoted in the Diabetes Forecast article written by Andrew Curry. Dr. Huang reportedly suggests that there may be a need for clinicians to consider whether diabetes treatment for elders (65+) may need to be different than the prevailing medical treatment regimen. The current medical treatment model follows a tight blood glucose regimen in treating many type 2 diabetics.

The problem is that historically, premier diabetes research has focused on middle-aged diabetics, not elders with diabetes, hence the value of Dr. Huang's project. Elders, on the other hand, face unique issues with advancing age and chronic health issues.

The tight blood glucose control model potentially lowers some diabetics' risks of health complications such as kidney disease and other chronic conditions. Generally, tight blood glucose control is successful, certainly among middle-aged diabetic populations. Among diabetic elders, however, the jury may still be out. Enter Dr. Elbert Huang, physician and demographer, asking all of the right questions about diabetes care for elders.

I am neither a doctor nor a medical professional. I don't need to be to understand the ramifications of doctors customizing diabetes treatments for their elderly patients. It's overdue.

Whether, or not, this potentially revolutionary diabetes research development is in time to help my octogenarian diabetic mother is not germane to the issue. It's exciting that premier physicians and demographers, including Dr. Huang and his contemporaries, are shining a research spotlight on the medical treatment needs of elders with diabetes.

Under Dr. Huang's model, what works for a 40 year old diabetic may not be the best course of treatment for someone like my mother. I couldn't agree more. Working in the trenches caring for a diabetic elder round-the-clock can be most enlightening.

Care Notes

When I decided to provide full-time assistive care to my mother, her blood glucose readings were soaring in the "out-of-range" column of the laboratory's computer-generated printouts. I'll just say that the "expected range" shown on the laboratory printout has always been "65-100."

Sixty-five? When Mom's blood glucose drops to 65, or even 70's or 80's-plus, her body does the talking. She feels, and sometimes exhibits, body jitters. Sometimes she simply says "something is not right," as she waves or circles a hand. Just as quickly, she is prone to stop speaking as her body assumes the lead. It's a diabetic language all her own. Best part, I am diabetic bilingual!

For as long as I can recall, Mom has intuited blood glucose shifts in her body. Certainly, she has been in tune to these shifts longer than I have been her caregiver. Neither Mom's doctors, nor I, want her blood glucose level to be in the 'expected' 60 - 80+ range.

Once, at a blood glucose of 55, Mom required middle-of-the-night emergency medical treatment. She could no longer speak. Her body started shutting down with the lowered blood sugar. Mom's verbal non-responsiveness began with her blood sugar still in the 60's and dropping. A 65 blood glucose reading may be ideal for some diabetic somewhere, but not my mother.

Interactive Diabetic Eldercare

The emergency medical team (EMT) did not stop trying to raise Mom's blood glucose level that night until her blood sugar climbed to 100 and remained stable for at least 30 minutes. Note to self - 100 blood glucose minimum is playing it safe for Mom. Check.

It may seem strange to tight blood glucose purists that my mother generally is at her conversational and clearest thinking self when her daytime blood glucose readings are closer to 140. The 140 depends on what else may be happening with her health, of course. That's another day and another elder diabetes story.

After that memorable night, I aggressively monitored Mom's blood glucose fluctuations, observing her body's reactions throughout. Even prior to the EMS night, already I had started independently tracking Mom's blood sugars using a simple customized log I developed. The log allowed ample room for care comments, dates, times and blood glucose readings.

I intuited that my layperson's care comments might start to tell a story that could prove helpful to my mother and her doctors in Mom's diabetes management, instead of an almost-exclusive adherence to "expected ranges" and equally rigid insulin administration as medically prescribed. Ideal blood glucose ranges and medically prescribed insulin doses are critical elements in diabetes care where medically directed.

I am not advising any caregiver to disregard or dismiss their elders' medically prescribed treatment regimen. That would neither be ethical nor safe. I am confidently saying that medical treatment of diabetic elders is best when administered in full context of the harsh realities and daily life complexities of individual elders. Tight blood glucose controls alone will never an elder's life make whole.

Though I have not had the honor of meeting Dr. Huang or any of his colleagues, I am impressed by Diabetes Forecast's breaking news of the elder diabetes research project. The news is a nod to the not-so-simple world of diabetes eldercare. Welcome to my diabetes eldercare world.

Elders' Quality of Life

I applaud Dr. Huang and his team of researchers and all clinicians who, not unlike Mom's doctor, are more rather than less receptive to customizing diabetes medical treatment regimens for elders. No one lives forever. Some elders in their 80's and 90's are simply happy to be alive. Some of those elders are not necessarily seeking to break records for their tightest blood glucose control self-care practices.

If anyone is deserving of less rigidity in their medical treatment regimens, elders with diabetes, if so inclined, have more than earned the right to greater, rather than more restrictive, quality of life with advancing age and while under lifetime medical supervision. After all, those very elders have done a whole lot right to have lived into their advancing old age. Even non-diabetics don't always manage to live as long.

This is one diabetes care development for which I am cheering. One day, I may need to rely on Dr. Huang's innovative research, though I hope not. Whether or not that day comes for me, I continue rooting for Dr. Huang and all elders with diabetes.

Diabetes care and treatment is always on the move. It's all good news. No doubt it gets better as clinicians increasingly listen to elders.

Sources, References and Additional Information

Diabetes Forecast, The Healthy Living Magazine, March 2010.

American Diabetes Association

University of Chicago Medical Center: Dr. Elbert Huang's Profile

University of Chicago Medical Center: [Article] "For Some Diabetics, Burden of Care Rivals Complications of Disease," 2007.