For many people, a diagnosis of diabetes seems to bring nothing but limitations and restrictions. But for 82-year-old Sandra, a diabetes diagnosis has translated into a great array of mealtime options. That's thanks to her home health aide, Betty.
Every morning, on her way to Sandra's Manhattan apartment, Betty swings by the supermarket for reconnaissance. "I tell her, apples are on sale today, the cabbage and collard greens look good," explains Betty. "And I ask, 'What do you have a taste for?' She has until noon to decide the menu, then I go shopping for dinner."
By getting Sandra involved in the decision-making and preparation (baking, no frying) and the taste-testing (spices, no salt), Betty finds that her 82-year-old client can be remarkably open-minded about trying new foods and changing her diet. No longer does she skip lunch and fry up chicken or oxtails for dinner. Instead, Sandra chooses a salad for lunch and something along the lines of baked, skinless chicken with spinach or cabbage for dinner. "We talk and commentate," says Betty. "She really participates in the meal, so she enjoys it more."
Living with Diabetes
More people than ever are living with Type 2, or adult-onset, diabetes. According to recent figures from the Centers for Disease Control and Prevention, diabetes affects 25.8 million Americans, or 8.3 percent of the population (including both diagnosed and undiagnosed cases). Nearly two million Americans were newly diagnosed last year. At Partners in Care, the licensed, not-for-profit home care agency that I run, we have many clients with diabetes, and I see the numbers only rising in the near future. The New York Times Magazine recently focused attention on the role sugar plays in America's diabetes epidemic as well.
Diabetic patients who need home care tend to fall into two groups:
For both categories of people living with diabetes, the "stuff" of daily life -- eating, walking and even putting on shoes -- must be understood through the lens of the disease, and this is where skilled home health aides play a vital role. Well-trained aides pay close attention to diabetes management while they carry out such daily tasks as shopping and cooking, helping with getting dressed and overseeing and assisting with managing medications and carrying out prescribed exercise routines.
All home health aides who receive their certification from a licensed agency in New York State are required to learn about diabetes care as part of their training. Licensed agencies like Partners in Care often augment that training with in-service education for experienced aides. "That means certified aides have the latest information about the disease, how it manifests, and what exactly are the direct tasks that they have to do that relate to the diabetes," says my colleague Mark Andaya, Director of Education and Quality Assurance at Partners in Care.
As I noted in Part I of this Specialty Care series, home health care is not a one-size-fits-all profession. When you or a loved one chooses certified home care from a licensed agency, you have the advantage of matching a caregiver's experience, expertise or training to your loved one's specific care needs, including diabetes.
Daily Care for Diabetes
Certified home health aides are often part of a larger team, responsible for day-to-day implementation of doctor's orders and a nurse's plan of care. Renata Gelman, RN, BSN, who is a clinical manager at Partners in Care, passes along some information that we give home health aides in their training and in the plan of care we create for our clients with diabetes.
1. Nutrition
This is the number one issue for someone with diabetes. "When a nurse creates a care plan for the client and the home health aide," explains Renata, "she's going to focus first on diet." When shopping and planning meals for someone with diabetes:
A caregiver should also make sure that a diabetic client has sugary items on hand in case of an emergency. "Always examine the refrigerator," says Renata, "and make sure that orange juice is present, or Coke or chocolate."
2. Hydration
Insulin dries out the natural moisture of the skin, so make sure someone with diabetes drinks enough water. Caregivers should check skin for dryness and encourage hydration. Renata suggests filling a pitcher to the maximum daily requirement in the morning, dispensing water by the cupful, and making sure the pitcher is empty by bedtime.
3. Exercise
Staying active is a critical part of keeping diabetes under control. While the patient might be resistant at first, caregivers must be persistent. Betty recommends being gentle -- yet firm. "At the beginning," Betty recalls of her client, "she didn't want to walk. She was very used to sitting in her chair. I'd say, Let's just walk around the table then sit back down. Next time, it was, 'Okay, now to the bathroom.' Start with baby steps, then, when they feel comfortable, add a little more."
4. Foot care
Because diabetes can cause nerve damage and numbness, especially in the feet, diabetics should wear comfortable, close-toed shoes to avoid injury, and aides should help patients inspect the feet regularly for damage (which the patient may not feel). Wounds heal slower, so wound prevention is paramount.
5. Vision care
Vision is also affected by diabetes, and aides are trained to "be their client's extra set of eyes," says Mark Andaya. This includes communicating with clients about how they are seeing and reading, and understanding that diabetics can experience fluctuation in their vision.
6. Doctor's orders and warning signs
To monitor and manage the disease, people with diabetes should have a detailed plan of care from their doctor. This includes when and how to check blood sugar and administer insulin, as well as when and how to take medications. Home health aides oversee -- and, under certain limited conditions, can assist with -- a patient's monitoring and managing of his or her diabetes.
Aides are also trained to recognize warning signs, indicating blood sugar is too high or too low. If the patient is unusually thirsty, is confused, or has a blood sugar reading of 200 or above, aides will immediately call the patient's doctor and the nurse managing the case.
Rules to Live By
When it comes to caring for any client -- in this case, one with diabetes -- Betty provides some wonderful words of wisdom. "Be very observant," she says, noting that if someone says they'll take their medication or eat or exercise in five minutes, check in five minutes to make sure it's done. "Be persistent when you need to be. But also be compassionate. Sometimes even those of us in good health don't want to do everything we're supposed to do."
Living with diabetes -- or caring for someone who is -- is an increasingly common story. Tell us your story, and share a tip for monitoring or managing the disease.
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Sadly, the simple solution is ignored because of a mystifying refusal to acknowledge that chronic high blood sugar is not a disease, but a symptom of insulin resistance. Insulin-resistance cannot be "cured" with drugs and injections of insulin (in fact, in the case of "Type II," taking insulin is probably the worst thing a person can do). The symptom of high blood glucose can be reversed by not eating those foods that convert to glucose. It is so common sense, that it boggles my mind why this is not the first, and only "prescription" for people with high blood glucose.
Those foods are easy to eliminate: sugar, starch, and grains.
Eat high fat and moderate protein as our bodies are meant to do.
Ranveig Elvebakk, MD Specializing in Weight & Nutrition, author "The Food Tree" and other amazing but self evident truths in Nutrition.
This becomes a huge problem when you receive the diagnosis. Most health care providers do not have the time to actually sit down and work on a one to one basis with each person. Many doctors also know nothing about nutrition anyway.
Many people get sent to a dietitian - sounds great, but when you are one person in a room with 12-30 other people, then you rapidly cover the basics, the patient is told eat good fats, limit your carbohydrates, have a good protein source every meal - well what does that mean to a normal individual. I had no idea which foods are good proteins, what is a carbohydrate etc.. So finally I find out skinless chicken and turkey are good proteins - does that mean every single meal the rest of my life I must eat chicken or turkey?
It is getting easier for many people these days because of the internet, but many long-term diabetics actually still believe they can have no dessert, no sugar, no corn or potato, plus on and on.
They restrict their menu so drastically every day that there is no pleasure in food anymore. What a horrible shame that is!
For a lot of help in staying safe check at www.allergy-and-diabetic-health.com
For one thing, there is no need not to eat the skin on chicken and turkey. The higher the fat content, the better for those of us with insulin-resistance because fat metabolism converts to ketones which do not require insulin for our bodies to utilize. The only exception is the artificial, processed, "fake fats" like margarines and most plant oils and transfats.
Eat whole, real foods such as full-fat dairy, well-marbled meats, eggs and non-starchy vegetables. In spite of a serious family history of insulin-resistance and the health issues that accompany poorly managed insulin-resistance (father and grandfather died of complications of "Type II"), I have never had an abnormal blood sugar reading and have eaten high-fat, low-carb for 11 years. Most of my family members are doing the same with the same results.
This is Kathi. Everything you say makes sense and yet it is against everything which is taught. I have never been told eat full-fat dairy, fatty meats and skinned poultry. But I have been advised to eat equal fats/proteins and double low carb fruits and veges.
It does not make sense to avoid the fats but add "good fats". I understand the avoidance of hydrogenated, trans fats etc (it's all man-made junk anyway) but if we are to rely on a 25/25 ratio of fats to proteins, why avoid them?
I have a family history, both sides, two of my relatives made it to 50. All died of diabetic complications. Some deserved it -they accepted a short lifespan to live as they desired. A couple though did not deserve it. They followed the directives and obviously failed. Me, I've made it to 57. I am having more problems now - making the rounds of more doctors till I get told there is nothing else left I know to try. So, your way is completely different - I haven't had a full fat dairy product in 40 years. Same for meats or a real egg. My blood sugars are never steady, I gain weight constantly, nerve pain is worsening, legs are becoming useless. You have heard the entire story.
Normally I am a rational person - I don't know a thing about you. But what you say makes sense to me. I will probably give it a try