Diabetic elders: symptoms and meal frequency
by Isabel Fawcett, SPHR
It could be diabetics' mantra- smaller meal portions, more frequent (healthy) snacks and regular meals. The theory is simple enough. Reality, however, is a mixed-bag for some diabetics and their caregivers.
My Dad had adult-onset diabetes. In retrospect, I would say that Dad lived his life in three-to-four-hour blocks of time courtesy of his diabetes and body's symptoms. He was the most self-disciplined diabetic I have ever met in my life, bar none.
Low Blood Sugar (Hypoglycemia)
During my childhood, young adulthood and pretty much for Dad's entire life as a diabetic, I remember him being in-step with his body's reactions, including occasional slight feelings of nausea, and blood glucose related "shakes," as I informally refer to the hand and upper body jitters some diabetics experience when their blood glucose takes a sudden nose dive. For my Dad, his physical symptoms were fairly consistent whenever his blood glucose level fell abruptly. Dad's low blood glucose symptoms included:
- Mild dizziness that was more a light-headed feeling rather than extreme dizziness
- An upper body weakness sensation that accompanied the light-headed, mild swirling sensation- a general malaise, of sorts
- Hand-trembling, shakes or "the jitters," as I have dubbed those ever-so-slight hand tremors
While Dad didn't suffer from low blood glucose levels very often, his self-awareness and self-discipline in identifying and quickly managing his body's diabetes related symptoms was admirable. His favorite snack, between meals, was crackers and cheese - not too many, just enough to keep his body moving forward until it was time to eat again. Generally, Dad was able to pre-empt extreme hunger pangs with frequent light snacking throughout the course of his days.
For his entire adult life, Dad never gained or lost a pound either way. Remarkably, his weight stayed constant. He never overate, nor was he ever on any diet trend. Dad ate to live, not lived to eat.
As an otherwise healthy diabetic for more than 25 years, Dad's body and self-discipline kept him on track to optimum health, all things considered. He was seldom sick. Dad's lifetime medical treatment regimen was limited to a single diabetic pill daily. Mercifully, he never required insulin injections. When he died decades ago, one of his ICU nurses mentioned to me that it was unusual (at the time) for Type 2 diabetics to remain on a single pill regimen for so many years without ever having to be prescribed daily insulin injections.
Dad was blessed to live a full life independently, including active retirement years, without ever requiring assistive care. Sadly, not every elder diabetic is so fortunate. Had the ICU nurse seen Dad's life long self-discipline, she may have understood what I could only intuit as a layperson. Self-discipline, including eating more than three meals daily, and portion control, may go a long way in successfully managing diabetes and its complications.
Rapidly Fluctuating Glucose is a Whole Different World
As full-time carer to Mom, now in her mid-80s and a diabetic, I live my life in three-to-four-hour blocks of time. No, I am not the diabetic. My Mom is. As her caregiver, I try to pulse her meals three to four hours apart in an effort to help her body stabilize its blood glucose in the short and long term. Sometimes her body cooperates with her caregiver police. Other times, it doesn't. Much depends whether Mom is feeling hungry, like clockwork, every three to four hours.
Needless to say, few people, if any, will always be ready and eager to eat on cue. I would imagine that not even lab mice consistently eat on cue. That's a not-so-minor care detail that requires my sustained flexibility as Mom's caregiver, chief cook and bottle-washer.
Even if, as a caregiver, I were to stand on my head, a diabetic's body will do whatever it is going to do in terms of its blood glucose levels. No one died and left me boss of how the human body responds on any given day, at any given moment in time. Other medical conditions, including common respiratory ailments, have been known to throw a diabetic's blood glucose out of whack. Even flu shots may send a diabetic's blood glucose soaring. Then, what?
Then I roll my carer's dice by relying on tried and true care practices in my feeble human and layperson's effort to ride out the temporary condition successfully. Blood glucose fluctuations are very much like waiting out a storm. You just never know what will happen next. Sit tight.
I do my best to remain intuitive and flexible to Mom's appetite as it ebbs and flows so that I may plan meal preparation around her body's hunger and ever-fluctuating blood glucose levels. Like Wile E. Coyote, Genius-at-Work (not!) I have a Plan B. My alternate plan is to have foods that may entice Mom to eat a light little something in-between regular meals to help her body keep moving forward until her next regularly scheduled meal. If she skips a regular meal due to iffy appetite, substitute snacks are a godsend.
Healthy Snacks Can Get Her Through
Yogurt, unsweetened or sometimes sweetened applesauce, saltine crackers and cheese, finger sandwiches - anything within reason to avoid recurring sudden drops in blood glucose levels while allowing her body to re-adjust to its normal functioning, including restored appetite.
Low blood sugar is significant because it can be life-threatening. Diabetics and their caregivers really don't want to go there if at all avoidable.
Watch For Alerts
Like Dad's high body alert instinct, there was a time when Mom had similar physical symptoms as warnings. For decades, she always recognized her body's symptoms whenever she experienced them. Invariably, Mom did what she needed to do to successfully mitigate her low blood sugar symptoms. Back then, I was not her caregiver. She didn't need anyone to assist her in her diabetes self-care routines until a couple years ago.
Unlike my Dad, one of Mom's low blood glucose symptoms is mental confusion. Once her blood sugar took a sudden nose-dive while she was driving. Confused by her body's sudden blood glucose nose-dive, she drove into an oncoming traffic lane. She found herself in her little Ford Escort facing a big rig. Mercifully Mom and the truck driver were able to safely stop their vehicles in time. That was more than two decades ago.
As Mom advances in age, however, her body's symptoms of low blood sugar seem less pronounced. Responsive to my inquiries, if I am lucky, she gives me a non-verbal cue of general malaise when her blood glucose starts spiraling downward. With her index finger, she makes a slow, mid-air circle. Her eyelids struggle to remain fully open as her upper body sways slightly. That is my one cue that she is feeling light-headed, maybe dizzy. Other times, she steadies herself by putting a hand on the wall for support, reasonably indicating more general malaise.
My first-line strategy is to safely help her sit comfortably. Next, I administer a quick blood glucose finger-prick test, generally followed by a glass of orange juice for Mom. I always let her know why she needs to drink the orange juice without delay. She is cooperative when I explain the circumstances. In fact, she is always cooperative about all of her diabetes care routines. I never cease to thank Mom for her sustained cooperation with diabetes care routines. It can't be easy for her after all these years.
Depending on the outcome of her blood sugar finger-prick test, once again I become Wile E. Coyote, Genius-at-Work, albeit generally with greater success than Wile E. If nothing else, I have learned that the human body will do what it is going to do, medically speaking, whether caregivers like me stand on our heads or not.
My head sure feels as if I've been standing on it a lot. I wonder why? Caregiver headstands can be a real pain in the head and sometimes in the neck. It's called stress, I believe? My hat's off to paid care workers in healthcare settings. I wonder how they juggle so many patients and residents 24/7.
Related Resources and Information
Healthline.com's "Low Blood Sugar Symptoms," December 31, 2007
American Diabetes Association's "Diabetes Super Foods"