by Laurel LeConte
Registered Dietitian, Certified Diabetes
Educator, Manager, MHC Diabetes Training and Care Centre
MANITOULIN—According to the Institute for Clinical Evaluative Studies, Manitoulin Island is number one for diabetes prevalence in the province of Ontario. Most people are aware that uncontrolled diabetes can lead to serious health complications. What many people may not realize is that older adults have special considerations for diabetes care and management.
In 2013, the Canadian Diabetes Association updated their clinical practice guidelines to reflect specific messages targeted at care for the older adult. A workshop was recently held with staff and residents at the Manitoulin Lodge nursing home to discuss these recommendations. This article represents some of the information that was shared with staff, residents and community members interesting in learning about caring for the older adult with diabetes.
Diabetes is associated with the aging process and rates generally increase with age. This is extremely relevant for healthcare provision on Manitoulin as seniors comprise a significant proportion of the current demographic. According to projections by the Ontario Ministry of Finance, the number of people aged 65 years and older living on Manitoulin will increase by approximately 790 individuals by the year 2020. This is expected to translate to even higher rates of diabetes on Manitoulin Island.
Individuals with diabetes should have their health closely monitored to prevent health problems caused by uncontrolled blood sugar levels. All individuals who have diabetes should be seen by a healthcare provider every three months or so. However, diabetes in the elderly is metabolically distinct from diabetes in younger people and the approach to therapy should be different. For example, older adults are at higher risk for having severe hypoglycemia (low blood sugar) which can pose serious health consequences. Also, many older adults do not physiologically recognize the symptoms of low blood sugar which places them at additional risks. For these reasons, the Canadian Diabetes Association advises that it is acceptable for older adults to have higher blood sugar targets than younger adults with diabetes, depending on their level of frailty. Patients are encouraged to discuss what targets they should be aiming for with their health care provider or diabetes education team. Furthermore, another consideration in caring for the older adult with diabetes is the type of medication being used to lower blood sugar. Due to the increased risks of low blood sugars observed in seniors, older adults are advised to avoid certain older versions of blood sugar lowering pills and insulins associated with higher rates of low blood sugars. Extended release versions of medications, classes of medications that don’t cause low blood sugars and analogue insulins are the current preferred methods of treatment.
Most people are aware that diet is another extremely important consideration for diabetes management. Another update to the practice guidelines is the general liberalization of diet recommendations for older adults, especially those living in nursing homes. Recent studies have demonstrated no superior benefit to serving patients a “diabetic diet” over a regular diet. Regular, balanced meals appear to offer a universal benefit without the need for additional restrictions or special foods typically recommended in the past. Examples of these principles were reviewed with participants of the workshop.
A common concern for individuals with diabetes is how to adjust care during periods of illness. Many people are not sure what medications they should take or hold if feeling unwell and unable to eat or drink. One concern during periods of acute illness is dehydration, which can pose serious health consequences in the older adult. Generally speaking, individuals with diabetes are recommended to continue to take insulin doses as prescribed during illness but to increase frequency of self-monitoring of blood sugars. Certain types of medications should be held if fluids are not being tolerated. Contacting a health care provider is recommended under the following conditions: intolerance of fluids, unable to bring blood sugar down with insulin/fluids, unable to bring blood sugar up to 4.0 mmol/L, rapid respiration or persistent fever. Individuals with diabetes are recommended to meet with their health care provider or diabetes education team to come up with an individualized “sick day” management plan.
The workshop was well received and a repeat session is planned in future. Individuals, organizations or groups are encouraged to contact the MHC Diabetes Training and Care Centre for information from a registered nurse or registered dietitian trained to provide specialized care in diabetes management.
The MHC Diabetes training and care centre provides service to Little Current, Mindemoya, Manitowaning, Gore Bay or Silver Water. If you would like more information on diabetes management for an individual or group, please call Christy at 705-368-2300 ext. 2415.
