Diabetes affects nearly >20% of adults older than 65 years in the US (CDC website, 2011). Diabetes mellitus (type 2 diabetes) occurs when the body fails to produce insulin appropriately or does not properly respond to insulin. Glucose, the fuel for various cells in human bodies, requires insulin, a hormone to absorb and suitably utilize it. Blood glucose level gets elevated when the insulin signaling mechanism gets compromised. This can lead to a host of metabolic abnormalities that leads to serious health complications. Complications caused by persistent elevated sugar level include heart disease, stroke, kidney failure blindness, foot amputation and blindness.
Many low income elderly cannot afford medication and are not well educated to self manage the symptoms (Klein, Jackson, Street, Whitacre & Klein, 2013). Many of them identify hospitals’ emergency rooms as usual source of care as opposed to primary care physician’s office (Hewitt, Smeeth, Chaturvedi, Bulpitt, & Fletcher, 2011). As a result, they often end up in emergency rooms due to elevated glucose levels and other complications that arise due to it. Frequent urination, feeling thirsty, shortness of breath, swollen feet, fruit like smell in breath are symptoms of elevated blood glucose level. It is possible to manage type 2 diabetes with proper exercise and a healthy diet.
However, for most patients, the doctor may need to prescribe oral medications such as metformin and/or insulin to adequately regulate and lower blood glucose levels. It is important to remember that diabetes is a progressive disease. For many patients who are not prescribed any medications at first, may need to take oral pills or insulin over time. People who cannot afford the medications often look for ways to reduce their medicine and supplies cost. It is extremely important to take the medication on time and in the correct dosage. The risks of diabetes related severe health complications go up in the absence of proper monitoring and treatment. Many community centers, local and state governments offer assistance in diabetes medication and testing supplies. Many drug companies also offer free medication to low income patients.
Another important tool control and manage diabetes is blood glucose monitoring. Monitoring reveals the actual concentration of blood glucose level at any time. It is vital to keep a log of test results. The doctor or nurse can more suitably suggest diabetes care plan based on information from the blood monitoring log. The doctor or nurse may also be able to suggest a more cost effective testing schedule. According to the American Diabetes Association the level of blood glucose must be 70-130 mg/dL before a meal and <180 mg/dL an hour after eating. HbA1C is another marker used in diabetes management that provides information about long term trend of blood glucose level. To ensure proper maintenance and care, HbA1C levels should be less than 7% in patients with diabetes (American diabetes association, 2013).
The most important tool in long term management of diabetes is lifestyle change. Many studies have undoubtedly established the benefits of a healthy diet, exercise, and weight loss in patients with diabetes. It is critical to remember that every pound lost results in gain of several health benefits. Exercise has been described as a wonder drug or “cure all”. Loss of excess body weight makes the cells more receptive to insulin. Weight loss also leads to lowering of blood pressure, improvement in blood circulation and reduction of risk of coronary heart disease. In addition to exercise, such as walking, running or dancing, consuming a well- balanced nutrient-dense diet is vital in diabetes care. Food groups, especially whole grains, fruits, vegetables, low-fat or fat-free milk or milk products, and lean meats and other protein sources should be eaten whenever possible (healthy people 2020). It is similarly important to lower the intake of fat, sodium and sugar rich foods. Exercise and weight loss may lower the dosage of medication. It is important to drink water before exercise.
Finally it is critical to talk to a nurse or doctor who can educate and counsel the patients’ in all areas of diabetes management and care. However, in some instances (blood glucose 240 mg/dL) it is critical that the patients call the doctor or visit ER. Smoking, alcohol, illness (cold) and stress also trigger an increase in blood glucose level.
References
Hewitt, J., Smeeth, L., Chaturvedi, N., Bulpitt, C.J., & Fletcher, A. E (2011). Self management and patient understanding of diabetes in the older person. Diabetic Medicine.
Klein, H.A., Jackson, S.M., Street. K., Whitacre, J.C., & Klein, G (2013). Diabetes Self-Management Education: Miles to Go. Nursing Reseach and Practice. Article ID 81012.http://dx.doi.org/10.1155/2013/581012
Center for disease control retrieved from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
Healthy People 2020 retrieved from http://www.healthypeople.gov/2020/topics objectives2020/overview.aspx?topicid=8
American diabetes association retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html
